Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features

Abstract

Background

Pituitary abscess is a rare and diagnostically challenging condition, as it often resembles pituitary adenoma in clinical, laboratory, and radiological features. Unlike typical adenomas, abscesses may present with mild and nonspecific signs of infection or hormonal disturbances. This report aims to analyse the clinical manifestations, diagnosis, risk factors for abscess formation, and management of this condition in our two patients, as well as cases reviewed from the literature.

Case presentation

Both patients were female, presenting with complaints of headache and visual disturbances, including bitemporal hemianopia caused by optic chiasm compression. Laboratory tests revealed elevated FT4 in patient 1 and hyperprolactinemia in patient 2, without systemic signs of infection such as leukocytosis (white blood cell count normal). MRI demonstrated rim-enhancing sellar lesions with central hypointensity and optic chiasm compression, findings highly suggestive of abscess rather than typical pituitary adenoma. Both patients underwent endonasal transsphenoidal hypophysectomy and received antibiotic therapy. The surgical procedure successfully removed the abscess with minimal complications, although the underlying infectious cause remained unidentified. Metronidazole and ceftriaxone therapy proved effective in improving the patients’ prognosis. The results demonstrated a favourable short-term prognosis; however, follow-up evaluation at three months revealed challenges in long-term management.

Conclusion

This finding differs from previous literature reports, none of which documented recurrence. We emphasize the importance of a thorough medical history and a multidisciplinary approach to optimize outcomes. Long-term radiological and clinical monitoring is essential for detecting potential recurrence or complications.