PITUITARY ABSCESS - A MEDICALLY TREATED C ASE

Pituitary abscesses are rare. The case reported here concerns a 28-yea r old African. Gradual development of diplopia over 6 months was the f irst clinical manifestation. Three months later this development had r eached a more severe and infectious context, with complete right ophth almoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated w ith thrombophlebitis of the cavernous sinus. An antibiotic therapy con sisting of cefotaxime and metronidazole administered for 1 month, and netilmicine for 15 days succeeded in controlling the infectious syndro me. This resulted in cure of visual disorders, reduction in size of th e CT scan image and reconstruction of the pituitary sella which had be en destroyed. The diagnosis of pituitary abscess should be made when c onfronted with an infectious syndrome (unexplained fever, repeated men ingitis). CT does not recognize the nature of the hypophyseal mass it shows : necrosis of a pituitary adenoma, giant aneurysm or craniophary ngioma may mimick local infection. Surgery confirms the diagnosis and is regarded as the best treatment The patient's life is threatened whe n meningitis is present, and the functional prognosis is poor when rec overy from visual disorders is compromised due to late diagnosis. In t his paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with ot her reported cases.