We present a rare case of a pituitary lesion, initially thought to be a tumor but subsequently discovered to be an abscess, with recommendations for early diagnosis and effective management in this potentially fatal condition.

Pituitary lesions, classically including pituitary adenomas, Rathke’s cleft cysts, and craniopharyngiomas, can cause bitemporal hemianopsia due to compression of the optic chiasm. In the appropriate setting, pituitary abscesses should also be considered as part of the differential diagnosis.  

We discuss a case of a 64 yo previously healthy nurse who presented with a known suprasellar lesion, initially thought to be a pituitary mass, who went 3 years without follow-up. She reportedly was involved in many car accidents during this time, suggestive of bitemporal hemianopsia. Her family also noted changes in her gait and subacute changes in her behavior, which progressed to a state of altered mental status. Vitals on presentation were notable for severe hypothermia and hypotension concerning for shock, and she was admitted to the ICU. CT head showed a sellar mass causing obstructive hydrocephalus. Physical exam was notable for constricted bilateral visual fields and a wide-based ataxic gait. MRI brain with and without contrast demonstrated a cystic lesion compressing the right posterior cerebral artery, which led to a right thalamic stroke.

She underwent transsphenoidal resection of the lesion and a right frontal external ventricular drain (EVD) was placed. During resection, purulent material was noted to be draining from the sella. She was treated with vancomycin, cefuroxime, and flagyl, which was narrowed to vancomycin when cultures turned positive for methicillin-resistant staph aureus (MRSA). She was eventually discharged to rehab.

Pituitary lesions should be treated early and effectively to prevent life-threatening complications. Abscesses can occur even in generally healthy individuals, especially in older adults who work in health-care settings.