2025 Proffered Presentations
S068: SECONDARY PITUITARY ABSCESSES WITHIN PAPILLARY CRANIOPHARYNGIOMAS: A REPORT OF TWO CASES
Roza Balin, MS1; Rimmer Ryan, MD2; Sacit Bulent Omay, MD, FAANS3; 1Yale University Department of Neurosurgery; 2Yale University Department of Otolaryngology; 3Yale University Department of Neurosurgery and Otolaryngology
Pituitary region abscesses are rare, comprising less than 1% of all pituitary lesions. They are classified as either primary or secondary, with primary abscesses occurring in a normal pituitary gland and secondary abscesses associated with underlying intrasellar pathologies such as craniopharyngioma, Rathke’s cleft cyst, or pituitary adenoma. Approximately one-third of pituitary region abscesses are secondary. Craniopharyngioma, a slow-growing benign tumor of the sellar and suprasellar regions, can cause significant endocrinological and neurological deficits due to its proximity to the hypothalamus and pituitary stalk. This study presents two cases of secondary pituitary abscesses within papillary craniopharyngiomas, highlighting their clinical presentation, management, and outcomes.
Case I: A 60-year-old male presented with a history of a sellar and suprasellar lesion diagnosed seven years prior, with progressive symptoms of hypogonadism, hypothyroidism, and headaches over the past three years. He experienced fatigue, nausea, mental status changes, and found to have bitemporal hemianopsia, severe hypopituitarism, and hyponatremia. A new brain MRI revealed an enlarging cystic lesion with diffusion-weighted imaging (DWI) changes. Endoscopic Endonasal Approach (EEA) surgery revealed a white viscous material, and cultures grew Staphylococcus and Corynebacterium species. Pathology confirmed a papillary craniopharyngioma with a BRAF mutation. The patient showed significant improvement following surgery, antibiotic therapy, and correction of hypopituitarism, with full recovery of vision and no recurrence on serial imaging.
Case II: Patient is 61-year-old female who was initially diagnosed with a sellar and suprasellar lesion 17 years before in another country. She underwent endocrinological assessment revealing Diabetes Insipidus (DI) and has been treated with desmopressin. She presented to emergency department with a one-week history of progressive headaches, decreased energy, nausea, fevers, bitemporal hemianopsia, severe hypopituitarism, with a new brain MRI revealing a large cystic lesion in the sellar and suprasellar space with DWI changes within the lesion. Patient underwent an Endoscopic Endonasal Approach (EEA) which revealed a white, viscous material. The cyst was evacuated. Sella was reconstructed. Pathology was nondiagnostic and cultures showed no growth. Patient improved after the surgical treatment, antibiotherapy and correction of hypopituitarism and her vision recovered. She represented to ED two weeks later with worsening vision and a new MRI showed recollection of the cyst. She was taken back marsupialization. New pathology sample confirmed papillary craniopharyngioma. Her vision recovered. She has been followed by serial imaging with no recurrence.
Conclusion: Secondary pituitary abscesses within craniopharyngiomas, although extremely rare, are serious conditions with a high mortality rate. They require urgent surgical intervention, antibiotic therapy, and management of endocrinological abnormalities. Both cases demonstrated significant clinical improvement post-treatment, emphasizing the importance of timely diagnosis and comprehensive and multidisciplinary management in these patients.