Pituitary Abscess with Preserved Pituitary Hormone Profile and Co-existing Pituitary Adenoma: A Case Report

Abstract Background: Pituitary abscess is a rare and potentially life-threatening sellar pathology, accounting for less than 1% of pituitary lesions. It frequently mimics a pituitary adenoma on imaging, and diagnosis is often made intraoperatively. Preserved pituitary hormonal function is uncommon and further complicates preoperative diagnosis, particularly when associated with an underlying sellar lesion. Case Presentation: A 39-year-old male presented with a four-month history of progressive bifrontal headache and retro-orbital pain, followed by one week of bilateral visual blurring. He was afebrile with no signs of systemic infection or meningism. Neurological and ophthalmological examinations were unremarkable. Laboratory investigations, including inflammatory markers and anterior pituitary hormonal profile, were within normal limits, except for incidental primary hypothyroidism. Magnetic resonance imaging revealed a 1.5 × 1.6 × 1.6 cm rim-enhancing sellar lesion with suprasellar extension, suggestive of a cystic pituitary adenoma. The patient underwent endoscopic transsphenoidal surgery, during which thick purulent material was encountered, confirming a pituitary abscess. The lesion was evacuated, and the sellar floor was reconstructed using a nasoseptal flap. Microbiological cultures were sterile, while histopathological examination demonstrated a coexisting pituitary adenoma. The postoperative course was uneventful, with complete resolution of symptoms. At two-year follow-up, the patient remained asymptomatic with no evidence of recurrence. Conclusion: Pituitary abscess should be considered in the differential diagnosis of cystic sellar lesions, even in the absence of endocrine dysfunction or systemic infection. A coexisting pituitary adenoma further increases diagnostic complexity. Early transsphenoidal drainage is both diagnostic and curative, with favorable long-term outcomes.