MON-023 Pituitary Abscess in a Patient with HIV and Neurosyphilis Leading to Panhypopituitarism

Abstract Disclosure: T. Avanessian: None. Q. Li: None. M. Luzuriaga: None. H. Awadh: None. Introduction: Pituitary abscess is a rare and potentially life-threatening cause of hypopituitarism. It is often associated with immunosuppressed states such as HIV. It typically presents with nonspecific symptoms, including fever, headache, visual disturbances, and endocrinologic abnormalities such as panhypopituitarism and diabetes insipidus. Diagnosis is supported by the characteristic brain MRI findings. We present a case of a pituitary abscess in a patient with AIDS and neurosyphilis. Case Report: A 28-year-old HIV-positive female was admitted to the ICU after being found unresponsive. On-site, her blood glucose was 18 mg/dL. There was clear evidence of a drug overdose. Seven weeks prior, she had been hospitalized for a generalized maculopapular rash and left eye vision loss. Syphilis was confirmed by serologic testing, and cerebrospinal fluid (CSF) analysis revealed 3 WBCs, elevated protein (51 mg/dL), and negative VDRL. Brain MRI identified a 1.3 x 1.7 x 1 cm rim-enhancing lesion in the pituitary gland without optic chiasm compression, raising suspicion for a pituitary abscess. She was treated with broad-spectrum antibiotics, including Penicillin G. Ophthalmologic evaluation confirmed ocular syphilis, with MRI findings of asymmetric enhancement in the left ocular uveal tract consistent with chorioretinitis and panuveitis.An abnormal cosyntropin stimulation test, along with an ACTH level of 2.8 pg/mL, confirmed central adrenal insufficiency. A low-normal free T4 supported the diagnosis of central hypothyroidism. The patient did not have diabetes insipidus. A repeat brain MRI showed resolution of the pituitary abscess. Hypoglycemia resolved after the initiation of hydrocortisone and levothyroxine. Conclusion: Panhypopituitarism often persists even after the resolution of the pituitary abscess, and most patients will require lifelong hormone replacement therapy. While neurosyphilis as a cause of pituitary abscess is extremely rare, it can occur in immunosuppressed individuals, such as those with HIV or a history of drug use. Presentation: Monday, July 14, 2025