Expanded endoscopic endonasal transsphenoidal resection of a rare concurrent sellar pituitary adenoma and suprasellar abscess: illustrative case.

BACKGROUND

The coexistence of pituitary adenoma and sellar abscess is exceedingly rare, posing diagnostic challenges due to nonspecific clinical and imaging features.

OBSERVATIONS: A 47-year-old female presented with a 6-month progressive visual decline. MRI revealed a 2.5-cm multicystic sellar-suprasellar lesion with irregular rim enhancement, suspicious for adenoma or craniopharyngioma. Endoscopic endonasal resection revealed typical adenoma tissue in the sellar region and a suprasellar abscess with thick yellow pus. Both lesions were completely resected in a single stage. Histopathological analysis confirmed nonfunctioning pituitary adenoma with concurrent acute suppurative inflammation. Cultures were negative. The patient received 6 weeks of intravenous antibiotic therapy. Postoperatively, transient diabetes insipidus and fever resolved spontaneously. At the 6-month follow-up, MRI showed complete resection with no recurrence, and the patient's vision significantly improved.

LESSONS: Pituitary abscess can rarely coexist with adenoma and mimic common sellar lesions. Single-stage endoscopic endonasal surgery enables simultaneous diagnosis and management of both pathologies. Prolonged antibiotic therapy based on histopathological evidence is essential even with negative cultures. https://thejns.org/doi/10.3171/CASE26194.