Diagnosis of pituitary abscess and treatment via transsphenoidal surgery: experience from 15 cases

•Our results show that most patients have hypopituitarism and headaches, while some present with weakness and diabetes insipidus (DI).•In addition, typical magnetic resonance imaging (MRI) shows pa of equal or low intensity on T1-weighted imaging (T1WI) and high or equal intensity on T2-weighted imaging (T2WI) with enhanced edges.•The use of novel laboratory diagnostic technology (mNGS) can diagnose pathogens in time, which is conducive to antibiotic guidance after surgery.•Apart from pituitary adenoma, Rathke fissure cyst, craniopharyngioma and other common diseases, other rare pituitary lesions also need to be identified.•The choice of surgical method mostly depends on the surgeon, and there is no significant difference between nasal endoscopy and microscope. Pituitary abscess is an often misdiagnosed, rare clinical disorder. To improve diagnostic accuracy and the efficacy of surgical and antibiotic therapy for patients with pituitary abscess, herein, we retrospectively reviewed 15 patients who presented with pituitary abscesses from 2005 to 2022. Retrospective study. Fifteen patients underwent transsphenoidal surgery and received antibiotic treatment. Complete details regarding medical history, clinical manifestations, laboratory examinations, imaging studies, and treatment strategies were obtained for all patients. Most patients presented with hypopituitarism and headaches, while some presented with fever, visual disturbances, and diabetes insipidus (DI). Abscesses showed significant annular enhancement post gadolinium injection. In most patients, pituitary abscess can be cured via microscopic or endoscopic drainage of the abscess followed by antibiotic treatment. Complete cure of pituitary abscess was observed in nine patients, with six cases of prolonged hypopituitarism and only one case of recurrence. Long-term hormone replacement therapy was effective in the postoperative management of hypopituitarism. The typical manifestations of pituitary abscess include hypopituitarism and headaches; the presence of an enhanced ring at the edge of the mass on contrast-enhanced magnetic resonance images (MRI) is highly suggestive of pituitary abscess. We recommend antibiotic treatment for 4–6 weeks postoperatively, based on the results of bacterial cultures or metagenomic next-generation sequencing (mNGS).