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Rathke’s cleft cyst infections and pituitary abscesses: case series and review of the literature

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Abstract

Purpose

Pituitary abscesses (PAs) are a rare clinical entity which may arise from normal pituitary tissue or underlying lesions within the gland. Rathke’s cleft cysts (RCCs) are not commonly associated with the development of PA.

Methods

Retrospective chart review of three patients with PAs within RCCs at a single university center and review of the literature.

Results

Three cases are reported. The first case presented with fever and headache and a history of prior surgery due to RCC and a recent respiratory tract infection. The second case had a history of recent skin infections and presented with sudden onset headache and hypopituitarism. In the third case, chronic visual field impairment prompted an ophthalmologic evaluation resulting in a diagnosis of an adenoma and an infected RCC. In all three cases, an endoscopic endonasal approach was performed to drain infected tissue and allowed microbiological identification of gram-positive cocci, followed by treatment with antibiotics for at least three weeks. Cases in the literature are scarce and the diagnosis is usually made intraoperatively due to non-specific manifestations and imaging. PAs arising from underlying pituitary lesions are less common than primary PAs. Differential diagnosis should include pituitary apoplexy, hypophysitis and other cystic lesions.

Conclusion

PAs occurring in RCCs are infrequent. Clinical manifestations are commonly subacute, without septic symptoms. Imaging is usually non-specific. Preoperative diagnosis is infrequent and a broad differential diagnosis should be considered. Empirical antimicrobial therapy should be initiated and adjusted after obtaining cultures to reduce the rate of recurrence and improve clinical outcomes.

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Authors and Affiliations

  1. Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    F. Aranda, R. Rojas & P. Villanueva

  2. Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    R. García, F. J. Guarda, F. Nilo & G. González

  3. Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile

    F. J. Guarda, F. Nilo, J. P. Cruz, C. Callejas & P. Villanueva

  4. Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    F. J. Guarda, F. Nilo & G. González

  5. Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    J. P. Cruz

  6. Otorhinolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    C. Callejas

  7. Department of Infectious Diseases, School of Medicine, PontificiaUniversidad Católica de Chile, Santiago, Chile

    M. E. Balcells

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  1. F. Aranda
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Correspondence to P. Villanueva.

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#Aranda F and García R are authors contributed equally to this study

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Aranda, F., García, R., Guarda, F.J. et al. Rathke’s cleft cyst infections and pituitary abscesses: case series and review of the literature. Pituitary 24, 374–383 (2021). https://doi.org/10.1007/s11102-020-01115-2

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  • DOI: https://doi.org/10.1007/s11102-020-01115-2

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