Abstract
Objectives Pituitary abscess (PA) is a rare disorder and preoperative diagnosis is difficult. This study aims to better understand the clinical manifestations, early diagnosis, and appropriate treatment of PA.Methods This study enrolled 24 Chinese patients who were referred to Huashan Hospital, Fudan University, China, from June 2016 through December 2020, and diagnosed as PA. Their medical records were retrospectively analyzed.Results The most common clinical manifestations were amenorrhea (83.3%), male hypogonadism (66.7%), headache (66.7%), and visual disturbances (58.3%). Anterior pituitary hypofunction was commonly seen in 87.5% of them. Positive pathogenic detection was obtained in 33.3% of the patients through smear, culture and metagenomic next generation sequencing (mNGS) of CSF and pus. Rim enhancement on magnetic resonance imaging (MRI) and hyperintense on diffusion-weighted imaging (DWI) were revealed in 47.6% and 83.3% of our patients respectively. Most of the patients underwent transsphenoidal sinus surgery, accompanied with postoperative anti-infective and hormone replacement therapy.Conclusions In patients with symptoms associated with hypopituitarism, with typical rim enhancement on MRI and DWI hyperintense, the possibility of PA should be considered. Comprehensive pathogenic detection of CSF and pus were needed, and the application of mNGS may enhance the preoperative diagnostic rate. Anti-infection treatment is highly recommended after transsphenoidal sinus surgery.