Rare secondary pituitary abscess arising in a craniopharyngioma: A case report and literature review

A pituitary abscess is an extremely rare condition, classified as either primary or secondary. Secondary pituitary abscesses can arise from pre-existing pituitary lesions such as craniopharyngiomas. The present study describes the case of a 59-year-old man with a secondary pituitary abscess originating from a craniopharyngioma, presenting with a 10-month history of progressive visual decline, dizziness, headaches, nausea and vomiting. Although there were no overt endocrine symptoms, hormonal evaluation revealed hypothyroidism and growth hormone axis suppression, along with elevated prolactin levels due to pituitary stalk effect. MRI showed chronic inflammation in the sellar and suprasellar regions. The patient was initially treated with antibiotics, but symptoms persisted, necessitating craniotomy. Intraoperatively, a cystic structure was incised, releasing white purulent material. Histopathology confirmed a papillary craniopharyngioma with marked inflammatory infiltration. Postoperatively, the patient showed clinical improvement with antibiotic therapy; however, residual pituitary insufficiency and mild diabetes insipidus required long-term management. This case underscores the importance of considering secondary pituitary abscesses in the differential diagnosis of sellar lesions with atypical presentations. It is one of the few reported cases of a pituitary abscess secondary to a papillary craniopharyngioma, highlighting the critical role of timely surgical intervention and the diagnostic value of histopathological confirmation. The publication of this case provides new insights into the diagnostic challenges and management strategies for this rare but life-threatening condition.