背景:垂体脓肿(PA)是一种罕见的疾病,尚不清楚。我们的目的是描述一个病例,并进行全面的系统评价,以探索目前的症状,放射学发现,内分泌异常和死亡率。
目的:为了识别出现的症状,放射学发现,内分泌异常和PA死亡率的预测因子。
方法:我们系统回顾了文献,以确定所有PA病例报告。关于陈述的数据,死亡率,放射学发现,内分泌异常和治疗被提取。
结果:我们从218篇文章中确定了488例符合纳入标准的患者。死亡率为5.1%,报告天数(OR1.0005,95%CI1.0001-1.0008,p<0.01)是唯一确定的死亡率独立预测因子。死亡率随着时间的推移而下降,2000年前发表的病例死亡率较高(OR6.92,95%CI2.80-17.90,p<0.001)。最常见的症状是头痛(76.2%),其次是视野缺陷(47.3%)。只有43%的人出现经典的感染迹象。磁共振成像(MRI)上最常见的成像特征是垂体的高T2和低T1信号,并伴有周围对比增强。超过一半(54.8%)为文化阴性,最常见的细菌是金黄色葡萄球菌(7.8%),真菌是曲霉菌(8.8%)。最常见的内分泌异常是垂体功能减退(41.1%),其次是尿崩症(24.8%)。虽然大多数患者的症状得到了缓解,超过一半(61.0%)的患者存在持续性内分泌异常.
结论:PA与显著的死亡率相关,延迟就诊会增加死亡风险。持续的内分泌异常是常见的。鉴于非特异性临床表现,MRI上垂体高T2,低T1和周围对比增强的出现应提示考虑这种罕见疾病。
Pituitary abscess (PA) is a rare condition and not well understood. We aimed to describe a case and perform a comprehensive systematic
review to explore presenting symptoms, radiological findings, endocrine abnormalities and mortality.
To identify presenting symptoms, radiological findings, endocrinological abnormalities and predictors of mortality for PA.
We systematically reviewed the literature to identify all case reports of PA. Data regarding presentation, mortality, radiological findings, endocrinological abnormalities and treatment was extracted.
We identified 488 patients from 218 articles meeting the inclusion criteria. Mortality was 5.1%, with days to presentation (OR 1.0005, 95% CI 1.0001-1.0008, p < 0.01) being the only identified independent predictor of mortality. Mortality rates have decreased over time, with cases published prior to 2000 having higher mortality rates (OR 6.92, 95% CI 2.80-17.90, p < 0.001). The most common symptom was headache (76.2%), followed by visual field defects (47.3%). Classical signs of infection were only present in 43%. The most common imaging feature on magnetic resonance imaging (MRI) was high T2 and low T1 signal of the pituitary gland with peripheral contrast enhancement. Over half (54.8%) were culture negative, with the most common bacterial organism being staphylococcus aureus (7.8%) and fungal organism being aspergillus (8.8%). The most common endocrine abnormality was hypopituitarism (41.1%), followed by diabetes insipidus (24.8%). Whilst symptoms resolved in most patients, persistent endocrine abnormalities were present in over half of patients (61.0%).
PA is associated with significant mortality, with delayed presentation increasing risk of mortality. Ongoing endocrinological abnormalities are common. Given the non-specific clinical presentation, the appearance of high T2, low T1 and peripheral contrast enhancement of the pituitary on MRI should prompt consideration of this rare disease.