Abstract
Background Pituitary abscess (PA) is a rare condition with significant mortality and morbidity. Presenting symptoms, radiological findings, endocrine abnormalities and predictors of mortality are not well understood.
Objectives To identify presenting symptoms, radiological findings, endocrinological abnormalities and predictors of mortality for PA.
Methods We systematically reviewed the literature to identify all previously reported cases of PA. Data regarding presentation, mortality, radiological findings, endocrinological abnormalities and treatment was extracted.
Results We identified 488 patients from 218 articles meeting the inclusion criteria. Mortality was 5.1%, with days to presentation (OR 1.0005,95%CI 1.0001–1.0008,p<0.01) being the only identified independent predictor of mortality. Mortality rates have decreased, with cases published prior to 2000 having higher mortality rates (OR 6.92,95%CI 2.80–17.90,p<0.001). The most common symptom was headache (76.2%), followed by visual field defects (47.3%). Classical signs of infection were only present in 43%.
The most common imaging feature on MRI was high T2 and low T1 signal of the pituitary gland with peripheral contrast enhancement. Over half (54.8%) were culture negative, with the most common bacterial organism being staphylococcus aureus (7.8%) and fungal organism being aspergillus (8.8%). The most common endocrine abnormality was hypopituitarism (41.1%). Whilst symptoms resolved in most patients, persistent endocrine abnormalities were present in the majority of patients (73.3%).
Conclusion PA is associated with significant mortality, with delayed presentation increasing risk of mortality. Ongoing endocrinological abnormalities are common. Given the non-specific clinical presentation, the appearance of high T2, low T1 and peripheral enhancement of the pituitary on MRI should prompt consideration.
