Pituitary Abscess Due to Staphylococcus Lugdunensis in a Patient with Lymphocytic Hypophysitis

ABSTRACT

Lymphocytic hypophysitis is a rare endocrine disease involving lymphocytic infiltration and chronic pituitary inflammation. Pituitary abscess is another rare disease which may be associated with underlying parasellar pathology. Here, we report a case of lymphocytic hypophysitis diagnosed with a pituitary abscess and recurrent suprasellar involvement after surgery. A 58-year-old female presented with headache, panhypopituitarism, and a pituitary lesion with thickening of the pituitary stalk. She had pituitary surgery and was diagnosed with lymphocytic hypophysitis associated with pituitary abscess. After antibiotic therapy, the lesion recurred with extension to the hypothalamus and compressive symptoms. She was operated in order to rule out recurrent abscess, and then, high dose glucocorticoid treatment was initiated. The headache and fever resolved within one week of glucocorticoid treatment and her visual field was completely normal. However, glucocorticoid treatment resulted in toxic hepatitis and had to be prematurely withdrawn limiting the entire treatment length to 12 weeks. 100 mg/day azothioprine was started after normalization of her liver enzymes. The pituitary lesion reduced more than 50% on the third month magnetic resonance imaging and she is still on follow-up without any recurrence. Lymphocytic hypophysitis may cause neurological deficits and complete loss of pituitary functions. The disease may rarely be complicated with abscess, therefore, careful evaluation and surgical treatment should be performed.