{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:32:09Z","timestamp":1791232329858,"version":"4.1.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Pituitary abscess (PA) is a rare but life-threatening condition, accounting for &lt; 1% of pituitary lesions. At a single center, 140 endoscopic transsphenoidal surgeries for pituitary lesion resection were performed since 2018, with 13 patients diagnosed with PA at an unusually high incidence rate of 9.2%. The aim of this study was to characterize the diagnostic criteria, symptoms, microbiological profile, radiological features, and endocrinological characteristics of PA, while exploring potential reasons for the increased frequency of PA in the post\u2013COVID-19 era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A single-center retrospective review of patients with primary and secondary PA from 2018 to 2024 was conducted. Diagnosis was confirmed through intraoperative pus detection or laboratory confirmation. A univariate analysis was performed to assess factors associated with postoperative hormonal disorders and the accuracy of MRI-based preoperative diagnosis. Univariate ANOVA was used for quantitative variables, and categorical variables were analyzed using the chi-square and Fisher\u2019s exact tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 13 patients (9 female, mean age 56.5 years) included in the analysis, risk factors were present in 30.8%. The most common symptoms at presentation were visual disturbance (69%), headache (53%), and pituitary insufficiency (38%). A correct preoperative diagnosis was made via MRI, based on characteristically high signal intensity on T1-weighted images, for 69% of patients. No infectious symptoms were observed. A bacterial agent was identified in 84.6% of patients, with gram-positive bacteria more common. Treatment included pus evacuation and postoperative antibiotics. Headaches resolved for all patients and visual deficits improved in 7 of 9 patients, but endocrine abnormalities persisted or newly developed in some cases. One patient (7.7%) experienced recurrence, and no deaths were recorded. The study period was from 2018 to 2024, with a substantial increase in the frequency of PA after 2020 (post\u2013COVID-19 era).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>MRI features of PA can mimic other pituitary pathologies. Pus evacuation remains the primary treatment. Preoperative antibiotics might be unnecessary in stable patients without signs of infection. The incidence of PA could be higher in the post\u2013COVID-19 era, possibly due to immune system changes and healthcare disruptions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.focus25467","type":"journal-article","created":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T12:05:41Z","timestamp":1761998741000},"page":"E7","source":"Crossref","is-referenced-by-count":1,"title":["Unusually high frequency of pituitary abscess in the post\u2013COVID-19 era: insights from a single-center experience"],"prefix":"10.3171","volume":"59","author":[{"given":"Marta","family":"Ko\u017aba-Goszty\u0142a","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Wroclaw 4th Military Clinical Hospital, Wroclaw;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasija","family":"Krzemi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wroclaw 4th Military Clinical Hospital, Wroclaw;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Bladowska","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw; and"},{"name":"Department of Radiology, Wroclaw 4th Military Clinical Hospital, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Szczepa\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wroclaw 4th Military Clinical Hospital, Wroclaw;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Czapiga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wroclaw 4th Military Clinical Hospital, Wroclaw;"},{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Orphanet J Rare Dis","first-page":"165","article-title":"Pituitary abscess: a case report and systematic review of 488 cases","volume":"18","author":"Stringer F","year":"2023","unstructured":"Stringer F, Foong YC, Tan A,  Pituitary abscess: a case report and systematic review of 488 cases. Orphanet J Rare Dis. 2023;18(1):165."},{"issue":"2","key":"b2","series-title":"J Neurosurg","first-page":"233","article-title":"Diagnosis and management of pituitary abscess: a review of twenty-four cases","volume":"95","author":"Vates GE","year":"2001","unstructured":"Vates GE, Berger MS, Wilson CB. Diagnosis and management of pituitary abscess: a review of twenty-four cases. J Neurosurg. 2001;95(2):233\u2013241."},{"issue":"2","key":"b3","series-title":"Pituitary","first-page":"189","article-title":"Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years","volume":"20","author":"Gao L","year":"2017","unstructured":"Gao L, Guo X, Tian R,  Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. Pituitary. 2017;20(2):189\u2013194."},{"key":"b4","series-title":"Int J Surg","first-page":"156","article-title":"STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery","volume":"72","author":"Agha R","year":"2019","unstructured":"Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg. 2019;72:156\u2013165."},{"issue":"7","key":"b5","series-title":"Clin Neurol Neurosurg","first-page":"957","article-title":"Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases","volume":"114","author":"Zhang X","year":"2012","unstructured":"Zhang X, Sun J, Shen M,  Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases. 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Case reports. Acta Radiol. 1998;39(5):490\u2013493."},{"issue":"6","key":"b9","series-title":"Neurol Res","first-page":"495","article-title":"MR imaging and CT of pituitary abscess: case report and review","volume":"18","author":"Kabuto M","year":"1996","unstructured":"Kabuto M, Kubota T, Kobayashi H,  MR imaging and CT of pituitary abscess: case report and review. Neurol Res. 1996;18(6):495\u2013498."},{"issue":"3","key":"b10","series-title":"J Formos Med Assoc","first-page":"267","article-title":"Pituitary abscess: CT and MRI findings","volume":"95","author":"Hwang SL","year":"1996","unstructured":"Hwang SL, Howng SL. Pituitary abscess: CT and MRI findings. 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Acta Neurochir (Wien). 1983;68(3-4):187\u2013193."},{"key":"b17","series-title":"World Neurosurg","first-page":"76","article-title":"Case report of a primary pituitary abscess and systematic literature review of pituitary abscess with a focus on patient outcomes","volume":"101","author":"Agyei JO","year":"2017","unstructured":"Agyei JO, Lipinski LJ, Leonardo J. Case report of a primary pituitary abscess and systematic literature review of pituitary abscess with a focus on patient outcomes. World Neurosurg. 2017;101:76\u201392."},{"issue":"3","key":"b18","series-title":"Pituitary","first-page":"267","article-title":"Pituitary abscess: report of four cases and review of literature","volume":"9","author":"Dutta P","year":"2006","unstructured":"Dutta P, Bhansali A, Singh P, Kotwal N, Pathak A, Kumar Y. Pituitary abscess: report of four cases and review of literature. 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J Neurosurg. 2001;95(2):233\u2013241."},{"issue":"2","key":"b3","series-title":"Pituitary","first-page":"189","article-title":"Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years","volume":"20","author":"Gao L","year":"2017","unstructured":"Gao L, Guo X, Tian R,  Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. Pituitary. 2017;20(2):189\u2013194."},{"key":"b4","series-title":"Int J Surg","first-page":"156","article-title":"STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery","volume":"72","author":"Agha R","year":"2019","unstructured":"Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg. 2019;72:156\u2013165."},{"issue":"7","key":"b5","series-title":"Clin Neurol Neurosurg","first-page":"957","article-title":"Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases","volume":"114","author":"Zhang X","year":"2012","unstructured":"Zhang X, Sun J, Shen M,  Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases. Clin Neurol Neurosurg. 2012;114(7):957\u2013961."},{"issue":"3","key":"b6","series-title":"Endocrinol Metab Clin N Am","first-page":"609","article-title":"Differential diagnosis of pituitary tumors","volume":"16","author":"Post KD","year":"1987","unstructured":"Post KD, McCormick PC, Bello JA. Differential diagnosis of pituitary tumors. Endocrinol Metab Clin N Am. 1987;16(3):609\u2013645."},{"issue":"2","key":"b7","series-title":"Br J Neurosurg","first-page":"139","article-title":"Pituitary abscess: a series of six cases","volume":"11","author":"Jain KC","year":"1997","unstructured":"Jain KC, Varma A, Mahapatra AK. Pituitary abscess: a series of six cases. Br J Neurosurg. 1997;11(2):139\u2013143."},{"issue":"5","key":"b8","series-title":"Case reports. Acta Radiol","first-page":"490","article-title":"MR findings in three pituitary abscesses","volume":"39","author":"Kashiwagi N","year":"1998","unstructured":"Kashiwagi N, Fujita N, Hirabuki N,  MR findings in three pituitary abscesses. Case reports. Acta Radiol. 1998;39(5):490\u2013493."},{"issue":"6","key":"b9","series-title":"Neurol Res","first-page":"495","article-title":"MR imaging and CT of pituitary abscess: case report and review","volume":"18","author":"Kabuto M","year":"1996","unstructured":"Kabuto M, Kubota T, Kobayashi H,  MR imaging and CT of pituitary abscess: case report and review. Neurol Res. 1996;18(6):495\u2013498."},{"issue":"3","key":"b10","series-title":"J Formos Med Assoc","first-page":"267","article-title":"Pituitary abscess: CT and MRI findings","volume":"95","author":"Hwang SL","year":"1996","unstructured":"Hwang SL, Howng SL. Pituitary abscess: CT and MRI findings. 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J Neurosci Rural Pract. 2018;9(3):441\u2013443."},{"issue":"5","key":"b13","series-title":"Acta Neurochir (Wien)","first-page":"521","article-title":"Aspergillus pituitary abscess","volume":"146","author":"Iplikcioglu AC","year":"2004","unstructured":"Iplikcioglu AC, Bek S, Bikmaz K, Ceylan D, G\u00f6kduman CA. Aspergillus pituitary abscess. Acta Neurochir (Wien). 2004;146(5):521\u2013524."},{"key":"b14","series-title":"World Neurosurg","first-page":"467","article-title":"Endoscopic endonasal transsphenoidal drainage of a spontaneous candida glabrata pituitary abscess","volume":"109","author":"Strickland BA","year":"2018","unstructured":"Strickland BA, Pham M, Bakhsheshian J, Carmichael J, Weiss M, Zada G. Endoscopic endonasal transsphenoidal drainage of a spontaneous candida glabrata pituitary abscess. World Neurosurg. 2018;109:467\u2013470."},{"issue":"4","key":"b15","series-title":"Neurosurgery","first-page":"864","article-title":"Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report","volume":"44","author":"Sahjpaul RL","year":"1999","unstructured":"Sahjpaul RL, Lee DH. Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report. Neurosurgery. 1999;44(4):864\u2013868."},{"issue":"3-4","key":"b16","series-title":"Acta Neurochir (Wien)","first-page":"187","article-title":"Pituitary abscess","volume":"68","author":"Bjerre P","year":"1983","unstructured":"Bjerre P, Riishede J, Lindholm J. Pituitary abscess. Acta Neurochir (Wien). 1983;68(3-4):187\u2013193."},{"key":"b17","series-title":"World Neurosurg","first-page":"76","article-title":"Case report of a primary pituitary abscess and systematic literature review of pituitary abscess with a focus on patient outcomes","volume":"101","author":"Agyei JO","year":"2017","unstructured":"Agyei JO, Lipinski LJ, Leonardo J. Case report of a primary pituitary abscess and systematic literature review of pituitary abscess with a focus on patient outcomes. World Neurosurg. 2017;101:76\u201392."},{"issue":"3","key":"b18","series-title":"Pituitary","first-page":"267","article-title":"Pituitary abscess: report of four cases and review of literature","volume":"9","author":"Dutta P","year":"2006","unstructured":"Dutta P, Bhansali A, Singh P, Kotwal N, Pathak A, Kumar Y. Pituitary abscess: report of four cases and review of literature. 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Am J Case Rep. 2025;26:e947794."},{"issue":"1","key":"b21","series-title":"Eur J Med Res","first-page":"262","article-title":"Pituitary abscess: a descriptive analysis of a series of 19 patients-a multi-center experience","volume":"29","author":"Xue Q","year":"2024","unstructured":"Xue Q, Shi X, Fu X,  Pituitary abscess: a descriptive analysis of a series of 19 patients-a multi-center experience. Eur J Med Res. 2024;29(1):262."},{"issue":"1","key":"b22","series-title":"BMC Infect Dis","first-page":"123","article-title":"Neurological syndromes associated with COVID-19: a multicenter study in Brazil","volume":"25","author":"de Moura Brasil Matos A","year":"2025","unstructured":"de Moura Brasil Matos A, Gomes ABF, Carvalho FMM,  Neurological syndromes associated with COVID-19: a multicenter study in Brazil. 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