目的:垂体脓肿(PA)仅占鞍区肿块的0.3-0.5%,缺乏特定的临床症状使得在没有手术活检的情况下难以诊断PA。在临床实践中,PA常被误认为是囊性垂体腺瘤,颅咽管瘤,还有Rathke的囊肿.因此,本研究旨在探讨PA诊断的挑战,并评估术中手术与术后抗生素治疗相结合的重要性.
方法:我们对19例经组织病理学诊断为PA的患者进行了回顾性分析。所有患者在接受全面的术前评估后接受了垂体腺瘤的经蝶入路手术(TSS),包括常规测试,内分泌测定,和影像学检查。此外,我们比较了垂体脓肿(PA)的不同治疗方法,以确定获得良好预后的最有效方法。
结果:PA最常见的症状是头痛,尤其是在额颞叶和顶点区域,从轻度到中度的严重程度。也经常观察到与垂体功能减退相关的症状,包括迟钝,冷灵敏度,疲劳,减肥,多尿,和闭经.12例患者内分泌学检查异常。正确诊断PA是具有挑战性的。在我们的研究中,没有一个患者在手术前被正确诊断为PA,许多鞍区病变被误诊。良好的预后主要归因于手术干预和积极的术后抗生素治疗。
结论:鉴于术前诊断不明确,典型的术中发现和有效的抗生素治疗比其他检查更能表明正确的诊断.在治疗方面,最佳的手术干预和积极的术后抗生素治疗有助于解决PA带来的挑战。
OBJECTIVE: Pituitary abscess (PA) accounts for only 0.3-0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke\'s cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment.
METHODS: We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis.
RESULTS: The most prevalent symptom of PA was headache, especially in the frontal-temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy.
CONCLUSIONS: Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.