A Rare Case of Pituitary Abscess in a Young Nigerian Woman

Abstract

Introduction: Pituitary abscess is a rare condition, which diagnosis is usually made during surgery. An uncommon cause of panhypopituitarism, pituitary abscess has not been reported in Nigeria before now to the best of our knowledge. The objective of this article is to report this first case of pituitary abscess in a young Nigerian woman. \nCase Report: A 16-year-old female presented with recurrent generalized convulsion, impaired consciousness, fever, and vomiting of few hours duration. History of a prior severe headache and visual impairment that has lasted three years was given by the mother. Examination revealed a small for age girl who was febrile, dehydrated, and unconscious. Treatment for acute bacterial meningitis was commenced with empirical antibiotics (intravenous Ceftriaxone 1 g 12 hourly for 10 days). With further bouts of seizure and recurrent vomiting, brain computed tomography (CT) scan was done three weeks after onset of illness and it showed widening of the sella turcica and an isodense mass with a well-defined margin (measuring 24 × 44 mm) within the sella turcica. A diagnosis of pituitary macroadenoma was made. Her pituitary hormones profile was within normal range but she had decreased plasma estrogen and morning cortisol. Follow-up assessment at 18 years revealed absence of female secondary sex characteristics, primary amenorrhea, and visual field defects. Intraoperatively, 15 mL of pus was drained from a pituitary abscess accessed via frontal craniotomy. Culture of the abscess yielded Listeria organisms sensitive to Ceftriaxone. Postoperative outcome was good. \nConclusion: Pituitary abscess may present initially with neurological and mass effect symptoms; definitive diagnosis is made during surgery.