Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine

Abstract

Pituitary abscess is an unusual cause of sella turcica enlargement. Because its presentation closely mimics that of a pituitary tumor, the condition is seldom recognized preoperatively. Most cases were of bacterial etiology; a single patient with a primary mycotic pituitary abscess secondary to Aspergillus species was reported. That patient died of diffuse Aspergillus meningoencephalitis following a transfrontal craniotomy. A woman with primary pituitary aspergillosis survived her infection with virtually intact pituitary function following a transsphenoidal approach which avoided contamination of CSF. Postoperative amphotericin-B and 5-fluorocytosine therapy probably contributed greatly to her survival. Factors that should alert the clinician to the presence of a pituitary abscess in a patient with sella turcica enlargement are prior episodes of meningitis, sinusitis or CSF abnormalities, including pleocytosis, depressed glucose and elevated protein.