Non-surgical management of pituitary abscess: Case series and literature review

Non-surgical management of primary pituitary abscesses is usually reserved for patients considered high-risk or unsuitable surgical candidates. Surgical drainage followed by long-term intravenous antibiotics is the current mainstay in the reviewed literature. However, surgical management frequently fails to provide pathogen identification, does not offer long-term endocrine improvement, and may cause progressive hypopituitarism whilst exposing the patients to the risks of surgery and general anesthesia. There is no available evidence to guide management decisions, and there may be a wider role for intravenous antibiotics without surgery. We sought to evaluate presentation, treatment, and outcomes in our series of non-surgically managed primary pituitary abscesses.

Retrospective analysis of patients' electronic records as part of a registered audit of practice and review of the literature (PUBMED).

All 4 patients in our cohort were managed non-surgically with long-term intravenous antibiotics. Three of the patients presented with visual failure, one with fever and confusion. All patients had evidence of partial anterior hypopituitarism. The outcomes, clinical and endocrine, are discussed with a follow-up of up to 60 months. Visual defects recovered in all patients. Endocrine disturbances remained in 3 patients and recovered fully in one patient. One patient required surgical drainage due to recurrence.

Non-surgical management can potentially produce outcomes similar to surgical drainage. This small sample of patients cannot offer statistically significant results; however, it will hopefully stimulate wider consideration and conversation about this very rare pathology.