Primary pituitary abscess with coexisting pyogenic meningitis: an unexpected diagnosis.

Primary pituitary abscess is a very rare disease most likely associated with pyogenic infection. A 27-year-old woman was initially diagnosed and treated as a case of acute pyogenic meningitis. In view of persistent headache, impaired visual fields, galactorrhea and menstrual irregularities, she underwent evaluation of pituitary mass lesion. Magnetic resonance imaging of the pituitary reported the mass as pituitary macroadenoma. However, transsphenoidal surgery revealed copious collection of purulent materials confirmed as pyogenic pituitary abscess. A follow-up magnetic resonance imaging of the pituitary 2 years later confirmed secondary empty sella. She has developed panhypopituitarism; she remains on appropriate anterior pituitary hormone replacement.