descriptive research journal

Descriptive Research and Qualitative Research

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• Eunsook T. Koh 2 &
• Willis L. Owen 2  

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Descriptive research is a study of status and is widely used in education, nutrition, epidemiology, and the behavioral sciences. Its value is based on the premise that problems can be solved and practices improved through observation, analysis, and description. The most common descriptive research method is the survey, which includes questionnaires, personal interviews, phone surveys, and normative surveys. Developmental research is also descriptive. Through cross-sectional and longitudinal studies, researchers investigate the interaction of diet (e.g., fat and its sources, fiber and its sources, etc.) and life styles (e.g., smoking, alcohol drinking, etc.) and of disease (e.g., cancer, coronary heart disease) development. Observational research and correlational studies constitute other forms of descriptive research. Correlational studies determine and analyze relationships between variables as well as generate predictions. Descriptive research generates data, both qualitative and quantitative, that define the state of nature at a point in time. This chapter discusses some characteristics and basic procedures of the various types of descriptive research.

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Koh, E.T., Owen, W.L. (2000). Descriptive Research and Qualitative Research. In: Introduction to Nutrition and Health Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1401-5_12

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Understanding Descriptive Research Designs and Methods

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• 1 Author Affiliation: Senior Nurse Scientist and Clinical Nurse Specialist, Office of Nursing Research & Innovation, Nursing Institute, Cleveland Clinic, Ohio.
• PMID: 31789957
• DOI: 10.1097/NUR.0000000000000493
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• What is descriptive research?

Last updated

5 February 2023

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Cathy Heath

Descriptive research is a common investigatory model used by researchers in various fields, including social sciences, linguistics, and academia.

Read on to understand the characteristics of descriptive research and explore its underlying techniques, processes, and procedures.

Analyze your descriptive research

Dovetail streamlines analysis to help you uncover and share actionable insights

Descriptive research is an exploratory research method. It enables researchers to precisely and methodically describe a population, circumstance, or phenomenon.

As the name suggests, descriptive research describes the characteristics of the group, situation, or phenomenon being studied without manipulating variables or testing hypotheses . This can be reported using surveys , observational studies, and case studies. You can use both quantitative and qualitative methods to compile the data.

Besides making observations and then comparing and analyzing them, descriptive studies often develop knowledge concepts and provide solutions to critical issues. It always aims to answer how the event occurred, when it occurred, where it occurred, and what the problem or phenomenon is.

• Characteristics of descriptive research

The following are some of the characteristics of descriptive research:

Quantitativeness

Descriptive research can be quantitative as it gathers quantifiable data to statistically analyze a population sample. These numbers can show patterns, connections, and trends over time and can be discovered using surveys, polls, and experiments.

Qualitativeness

Descriptive research can also be qualitative. It gives meaning and context to the numbers supplied by quantitative descriptive research .

Researchers can use tools like interviews, focus groups, and ethnographic studies to illustrate why things are what they are and help characterize the research problem. This is because it’s more explanatory than exploratory or experimental research.

Uncontrolled variables

Descriptive research differs from experimental research in that researchers cannot manipulate the variables. They are recognized, scrutinized, and quantified instead. This is one of its most prominent features.

Cross-sectional studies

Descriptive research is a cross-sectional study because it examines several areas of the same group. It involves obtaining data on multiple variables at the personal level during a certain period. It’s helpful when trying to understand a larger community’s habits or preferences.

Carried out in a natural environment

Descriptive studies are usually carried out in the participants’ everyday environment, which allows researchers to avoid influencing responders by collecting data in a natural setting. You can use online surveys or survey questions to collect data or observe.

Basis for further research

You can further dissect descriptive research’s outcomes and use them for different types of investigation. The outcomes also serve as a foundation for subsequent investigations and can guide future studies. For example, you can use the data obtained in descriptive research to help determine future research designs.

• Descriptive research methods

There are three basic approaches for gathering data in descriptive research: observational, case study, and survey.

You can use surveys to gather data in descriptive research. This involves gathering information from many people using a questionnaire and interview .

Surveys remain the dominant research tool for descriptive research design. Researchers can conduct various investigations and collect multiple types of data (quantitative and qualitative) using surveys with diverse designs.

You can conduct surveys over the phone, online, or in person. Your survey might be a brief interview or conversation with a set of prepared questions intended to obtain quick information from the primary source.

Observation

This descriptive research method involves observing and gathering data on a population or phenomena without manipulating variables. It is employed in psychology, market research , and other social science studies to track and understand human behavior.

Observation is an essential component of descriptive research. It entails gathering data and analyzing it to see whether there is a relationship between the two variables in the study. This strategy usually allows for both qualitative and quantitative data analysis.

Case studies

A case study can outline a specific topic’s traits. The topic might be a person, group, event, or organization.

It involves using a subset of a larger group as a sample to characterize the features of that larger group.

You can generalize knowledge gained from studying a case study to benefit a broader audience.

This approach entails carefully examining a particular group, person, or event over time. You can learn something new about the study topic by using a small group to better understand the dynamics of the entire group.

• Types of descriptive research

There are several types of descriptive study. The most well-known include cross-sectional studies, census surveys, sample surveys, case reports, and comparison studies.

Case reports and case series

In the healthcare and medical fields, a case report is used to explain a patient’s circumstances when suffering from an uncommon illness or displaying certain symptoms. Case reports and case series are both collections of related cases. They have aided the advancement of medical knowledge on countless occasions.

The normative component is an addition to the descriptive survey. In the descriptive–normative survey, you compare the study’s results to the norm.

Descriptive survey

This descriptive type of research employs surveys to collect information on various topics. This data aims to determine the degree to which certain conditions may be attained.

You can extrapolate or generalize the information you obtain from sample surveys to the larger group being researched.

Correlative survey

Correlative surveys help establish if there is a positive, negative, or neutral connection between two variables.

Performing census surveys involves gathering relevant data on several aspects of a given population. These units include individuals, families, organizations, objects, characteristics, and properties.

During descriptive research, you gather different degrees of interest over time from a specific population. Cross-sectional studies provide a glimpse of a phenomenon’s prevalence and features in a population. There are no ethical challenges with them and they are quite simple and inexpensive to carry out.

Comparative studies

These surveys compare the two subjects’ conditions or characteristics. The subjects may include research variables, organizations, plans, and people.

Comparison points, assumption of similarities, and criteria of comparison are three important variables that affect how well and accurately comparative studies are conducted.

For instance, descriptive research can help determine how many CEOs hold a bachelor’s degree and what proportion of low-income households receive government help.

• Pros and cons

The primary advantage of descriptive research designs is that researchers can create a reliable and beneficial database for additional study. To conduct any inquiry, you need access to reliable information sources that can give you a firm understanding of a situation.

Quantitative studies are time- and resource-intensive, so knowing the hypotheses viable for testing is crucial. The basic overview of descriptive research provides helpful hints as to which variables are worth quantitatively examining. This is why it’s employed as a precursor to quantitative research designs.

Some experts view this research as untrustworthy and unscientific. However, there is no way to assess the findings because you don’t manipulate any variables statistically.

Cause-and-effect correlations also can’t be established through descriptive investigations. Additionally, observational study findings cannot be replicated, which prevents a review of the findings and their replication.

The absence of statistical and in-depth analysis and the rather superficial character of the investigative procedure are drawbacks of this research approach.

• Descriptive research examples and applications

Several descriptive research examples are emphasized based on their types, purposes, and applications. Research questions often begin with “What is …” These studies help find solutions to practical issues in social science, physical science, and education.

Here are some examples and applications of descriptive research:

Determining consumer perception and behavior

Organizations use descriptive research designs to determine how various demographic groups react to a certain product or service.

For example, a business looking to sell to its target market should research the market’s behavior first. When researching human behavior in response to a cause or event, the researcher pays attention to the traits, actions, and responses before drawing a conclusion.

Scientific classification

Scientific descriptive research enables the classification of organisms and their traits and constituents.

Measuring data trends

A descriptive study design’s statistical capabilities allow researchers to track data trends over time. It’s frequently used to determine the study target’s current circumstances and underlying patterns.

Conduct comparison

Organizations can use a descriptive research approach to learn how various demographics react to a certain product or service. For example, you can study how the target market responds to a competitor’s product and use that information to infer their behavior.

• Bottom line

A descriptive research design is suitable for exploring certain topics and serving as a prelude to larger quantitative investigations. It provides a comprehensive understanding of the “what” of the group or thing you’re investigating.

This research type acts as the cornerstone of other research methodologies . It is distinctive because it can use quantitative and qualitative research approaches at the same time.

What is descriptive research design?

Descriptive research design aims to systematically obtain information to describe a phenomenon, situation, or population. More specifically, it helps answer the what, when, where, and how questions regarding the research problem rather than the why.

How does descriptive research compare to qualitative research?

Despite certain parallels, descriptive research concentrates on describing phenomena, while qualitative research aims to understand people better.

How do you analyze descriptive research data?

Data analysis involves using various methodologies, enabling the researcher to evaluate and provide results regarding validity and reliability.

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• Descriptive Research Design | Definition, Methods & Examples

Descriptive Research Design | Definition, Methods & Examples

Published on 5 May 2022 by Shona McCombes . Revised on 10 October 2022.

Descriptive research aims to accurately and systematically describe a population, situation or phenomenon. It can answer what , where , when , and how   questions , but not why questions.

A descriptive research design can use a wide variety of research methods  to investigate one or more variables . Unlike in experimental research , the researcher does not control or manipulate any of the variables, but only observes and measures them.

Table of contents

When to use a descriptive research design, descriptive research methods.

Descriptive research is an appropriate choice when the research aim is to identify characteristics, frequencies, trends, and categories.

It is useful when not much is known yet about the topic or problem. Before you can research why something happens, you need to understand how, when, and where it happens.

• How has the London housing market changed over the past 20 years?
• Do customers of company X prefer product Y or product Z?
• What are the main genetic, behavioural, and morphological differences between European wildcats and domestic cats?
• What are the most popular online news sources among under-18s?
• How prevalent is disease A in population B?

Prevent plagiarism, run a free check.

Descriptive research is usually defined as a type of quantitative research , though qualitative research can also be used for descriptive purposes. The research design should be carefully developed to ensure that the results are valid and reliable .

Survey research allows you to gather large volumes of data that can be analysed for frequencies, averages, and patterns. Common uses of surveys include:

• Describing the demographics of a country or region
• Gauging public opinion on political and social topics
• Evaluating satisfaction with a company’s products or an organisation’s services

Observations

Observations allow you to gather data on behaviours and phenomena without having to rely on the honesty and accuracy of respondents. This method is often used by psychological, social, and market researchers to understand how people act in real-life situations.

Observation of physical entities and phenomena is also an important part of research in the natural sciences. Before you can develop testable hypotheses , models, or theories, it’s necessary to observe and systematically describe the subject under investigation.

Case studies

A case study can be used to describe the characteristics of a specific subject (such as a person, group, event, or organisation). Instead of gathering a large volume of data to identify patterns across time or location, case studies gather detailed data to identify the characteristics of a narrowly defined subject.

Rather than aiming to describe generalisable facts, case studies often focus on unusual or interesting cases that challenge assumptions, add complexity, or reveal something new about a research problem .

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Yusuf, M, Syahputra, F. P., Lubis, A. A., Aswani, A., & Tambunan, R. W. (2024). Developing Genre-based English Worksheet for Vocational Students by Using 4-D Development Model to Improve Writing Skill. World Journal of English Language, 14(1), 65–72.

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• Open access
• Published: 02 May 2024

Pituitary abscess: a descriptive analysis of a series of 19 patients—a multi-center experience

• Qiang Xue 1   na1 ,
• Xiuhua Shi 2   na1 ,
• Xiaoling Fu 3   na1 ,
• Yating Yin 1 ,
• Hui Zhou 4 ,
• Suiyi Liu 5 ,
• Qingfang Sun 6 ,
• Jin Meng 7 ,
• Liuguan Bian 6 ,
• Hong Tan 8 &

European Journal of Medical Research volume  29 , Article number:  262 ( 2024 ) Cite this article

49 Accesses

Metrics details

Pituitary abscess (PA) accounts for only 0.3–0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke’s cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment.

We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis.

The most prevalent symptom of PA was headache, especially in the frontal–temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy.

Conclusions

Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.

Introduction

Pituitary abscess (PA) accounts for only 0.3–0.5% of sellar masses, and the epidemiological studies suggest that it accounts for less than 0.2–1% of all pituitary lesions [ 1 , 2 ]. PA can be classified into primary and secondary forms. Primary PA occurs in normal pituitary tissue and is typically caused by the spread of local infections, such as sphenoid sinusitis, meningitis, intracranial infection caused by cerebrospinal fluid leakage, cavernous sinus thrombosis, or infection following transnasal sphenoid surgery. Secondary PA refers to an abscess following pituitary lesions, such as pituitary adenoma, Rathke's cyst, or craniopharyngioma. Approximately one-third of secondary PA patients with pituitary disorders were reported in the literature [ 3 ].

Common clinical manifestations of PA include headaches, visual disturbances, hypopituitarism, and meningeal irritation resulting from abscess compression of surrounding structures [ 4 ]. Nevertheless, the absence of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy.

Combining the imaging features of computed tomography (CT) scanning and magnetic resonance imaging (MRI) in the anterior skull base and diaphragm sellae with clinical manifestations [ 5 , 6 ] has been suggested as an effective non-invasive method for the diagnosis of PA. In the meantime, another researcher has demonstrated that symptoms such as meningitis, sinusitis, sepsis, and rapid neurological deterioration could be indicative of abscess formation due to pituitary adenoma [ 7 ]. Moreover, Anagnos emphasized the importance of diabetes insipidus (DI) as a characteristic symptom for distinguishing adenoma from PA in patients [ 8 ]. In clinical practice, the PA is frequently confused with cystic pituitary adenoma, craniopharyngioma, and Rathke’s cyst.

In the present study, we sought to classify the clinical characteristics of PA by analyzing a cohort of 19 patients from three medical centers, providing clinicians with a diagnostic reference for PA. Furthermore, we compared various treatments for PA to identify the most efficacious method for achieving a favorable prognosis.

Materials and methods

We retrospectively reviewed 19 patients diagnosed with PA from Shanghai Ruijin Hospital, Shanghai Changzheng Hospital, and Hunan Xiangya Hospital between May 2017 and November 2022. Inclusive criteria include (1) Patients diagnosed with PA with histological evidence of acute or chronic inflammation and abscess wall; (2) Patients who completed the whole treatment process in our center. Exclusion criteria are as follows: (1) conservative patients who could not be diagnosed with PA; (2) patients who died during hospitalization due to other diseases; and (3) patients who lost follow-up after discharge. After enrolling, we documented their presenting symptoms, including fever, typical imaging findings, endocrine observations, and drainage of pus-containing organisms. Each patient underwent a comprehensive medical history review, followed by thorough neurological and ophthalmologic assessments. Preoperatively and postoperatively (from 3 months to 9 years), contrast-enhanced MRI scans were performed, with concurrent monitoring of baseline and postoperative endocrine functions over time. All 19 patients underwent transsphenoidal surgery for abscess evacuation. In addition, all patients received both oral and intravenous antibiotics. The earliest patients to use antibiotics were taken 3 days before surgery, while most patients taking them after surgery, with a time span from 3 days before surgery to 4 weeks after surgery. Hormone replacement therapy was given to patients that suffered from hypopituitarism. All our centers routinely performed follow-ups through outpatient visits and telephone interviews.

General characteristics

The mean age of the 19 patients in this cohort was 43.4 years (ranging from 16 to 77 years), with 12 females and 7 males. The mean follow-up period was 45.3 months (ranging from 2 to 112 months). All patients had no history of radiotherapy or chemotherapy, immunosuppressant application, AIDS, alcohol or drug abuse. None of these patients had undergone previous surgery for pituitary or sphenoid sinus lesions. Five (26%) had a history of possible infection: two with submandibular lymphnoditis, one with sphenoid sinusitis, and another two with previous cholecystitis (Table  1 ).

The most common symptom in our series was headache, affecting a substantial proportion (11, 58%) of patients. Most complained of long-standing headaches in the frontal–temporal and vertex areas ranging from mild to moderate degrees. In contrast, only one patient experienced a severe headache at the onset. Hypopituitarism-related symptoms were also common (6, 32%) at presentation, such as hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Five patients (26%) suffered from visual disturbances, either unilateral or bilateral changes in their visual fields, visual acuity or double vision. Four patients (21%) presented with elevated peripheral white blood cell (WBC) counts, and three (16%) presented with febrile. Three patients (16%) experienced nausea and vomiting, including two presenting with febrile and one with elevated peripheral WBC counts and drowsiness. One patient suffered from polyuria and polydipsia, with polyuria occurring more than ten times per day, and drinking more than 1.5-L water daily.

Endocrinology assays

Twelve patients were found to have abnormalities following endocrinology examinations conducted on all patients. Endocrinology tests revealed potential deficiencies in thyroid, adrenal cortical, and gonad function (Table  2 ).

Imaging studies

Sellar MRI is often considered the most valuable and indicative diagnostic tool for identifying sellar lesions. MRI can reveal enlargement of the sellar turcica. Many of these abscesses exhibited moderate to high signal intensity on T2-weighted images (T2WI), indicative of a fluid-containing cyst. T1-weighted images (T1WI) demonstrated that the masses, when compared with the surrounding brain, tended to exhibit signal characteristics ranging from hypointense to mildly hyperintense, while T2WI demonstrated peripheral or rim enhancement. In two cases, "waist" and "gourd" shapes were also present. Fourteen patients (74%) exhibited a hypo-intense signal of sellar mass on T1WI, with two (10%) showing a hyper-intense signal and three (16%) showing an iso-intense signal. Nine cases (47%) demonstrated a hyperintense sellar mass with the peripheral contrast-enhancing rim on T1WI (due to increased protein content), while ten (53%) exhibited significantly abnormal, uneven enhancement of the pituitary (Fig.  1 ; Table  3 ).

MRI of PA preoperative: A T1WI coronal: iso-hyperintense signal; B T1WI sagittal: iso-hyperintense signal; C T2WI coronal: hyperintense signal revealed a sellar heterogeneous; D T2WI sagittal: hyperintense signal; E T1WI coronal contrast-enhanced: heterogeneous hyperintense signal, lesion with rim enhancement; F T1WI sagittal contrast-enhanced: heterogeneous hyperintense signal, lesion with enhancement

Preoperative diagnosis

None were accurately diagnosed with PA prior to surgery. Twelve (63%) patients were preoperatively diagnosed as pituitary adenoma, two (10%) as pituitary adenoma with apoplexy, and the remaining (27%) patients were misdiagnosed as Rathke's cyst.

Intraoperative exploration and management

Various mixtures were observed, including creamy or white-green pus, and viscous or jelly-like substances. The intrasellar cystic mass of capsule specimens was completely excised, with volumes ranging from 1 to 9 mL. To prevent infection, the sellar was irrigated with a large amount of saline, gentamicin, or povidone-iodine and packed with a small lump of abdominal fat, guided by a provisional diagnosis of PA. The anterior wall of the sellar was reconstructed using vomer bone, sealed with fibrin glue to prevent and minimize intraoperative and postoperative complications.

Pathological examination

The intraoperative frozen section revealed features of PA, including an abscess wall rich in foamy histiocytes (Fig.  2 ), as well as pituitary tissue degeneration and necrosis with accompanying inflammatory cell infiltration. In contrast, the paraffin section confirmed the diagnosis of PA. A histological examination of pus and the abscess wall confirmed the presence of inflammatory cells. Only one of the Gram-stained or cultured samples tested positive for staphylococcus, while the others tested negative (Table  4 ).

Reveals a lymphocyte-infiltrated abscess wall; the arrow indicates a foamy histiocyte (hematoxylin–eosin stain)

Medical treatment

Antibiotics are typically administered for more than 2 weeks, while endocrine replacement therapy for hypopituitarism related to pituitary function usually lasts for 1–2 weeks. In our clinical practice, suspected pituitary abscesses may be treated empirically with oral antibiotics to observe changes in pituitary imaging. Upon diagnosis of pituitary abscess, intravenous antibiotics are the primary treatment choice, supplemented by oral antibiotics and nasal topo-anti-infective. Monitor pituitary function by adjusting levels of hydrocortisone acetate before and after surgery. For instance, 100 mg of succinate hydrocortisone was initially administered intravenously for about 3 days, followed by a reduction to 25 mg taken orally twice daily at 8 ante meridiem(AM) and 4 post meridian(PM), respectively, and subsequently decreased to 25 mg once daily at 8 AM. Additional supportive postoperative care, including hemostasis, gastric mucosal protection, management of diabetes insipidus and potassium abnormalities, and emotional support, is also necessary.

Follow-up and prognosis

Follow-up periods in our cohort ranged from 2–112 weeks. All patients with preoperative headaches experienced significant symptom improvement, as did the five patients with visual disturbances. Two patients experienced recurrence 6 years and 5 months apart, necessitating a second operation. Currently, all patients have fully resumed normal activities.

Epidemiology and etiology

Since Simmonds reported the first case of PA in 1914, over 210 cases have been documented in the medical literature [ 9 , 10 ]. PA is most prevalent between the ages of 3 and 69, with a clinical incidence rate ranging from 0.3% to 0.5% of sellar masses, irrespective of age or gender [ 11 , 12 ]. According to our research, it represented 0.4% of all lesions in the sellar region. In terms of etiology, PA can be classified into primary and secondary PA based on the pathogenic organism involved. Primary PA occurs in normal pituitary tissue and is typically caused by the spread of local infection.

In contrast, secondary PA is an abscess that develops after pituitary lesions such as pituitary adenoma, Rathke's cyst, craniopharyngioma, or sellar surgery. [ 13 , 14 , 15 ]. The source of infection cannot be identified in more than 60% of PA cases, which may be attributed to cryptogenic causes [ 16 ]. In our cohort, fourteen patients (74%) showed no evidence of infection, while two had submandibular lymphnoditis, one had sphenoid sinusitis, and two had a history of cholecystitis.

Clinical manifestations

Headache (91.7%) and visual disturbances (58%) are the most common symptoms, according to the literature [ 17 , 18 ]. Danilowicz reported that 75–100% of patients with visual impairment and visual field defects, 54.2% of patients had anterior pituitary dysfunction, resulting in diverse clinical manifestations such as adrenocortical adenoma, adrenocortical adenoma, adrenocortical ade decreased libido, cold intolerance, amenorrhea, polyuria, and polydipsia, and it may lead to panhypopituitarism [ 19 ]. DI almost accounts for nearly 50% of PA compared to 10% of pituitary adenoma, suggesting that DI can be helpful in diagnosing PA [ 20 ]. In addition, approximately 33.3% of patients presented with fever, 33.3% had an elevated white blood cell count, and 25% had meningismus [ 21 ]. In our cohort, six patients (32%) exhibited symptoms related to hypopituitarism, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea, five patients (26%) experienced visual disturbances, four patients (21%) had elevated peripheral WBC counts, and three patients(16%) presented with febrile illness (Table  5 ). In addition, three patients (16%) experienced nausea and vomiting, while only one exhibited symptoms of polyuria and polydipsia. Sometimes, cases lacking inflammatory or meningeal symptoms may be associated with mass abscess effect [ 22 , 23 ]. Studies have revealed that pituitary hormone deficiency is typical among PA patients, as the abscess can obstruct the hypothalamus or pituitary stalk release [ 24 ]. Dutta found that pituitary stalk lesions block the production of PRL release inhibitors, resulting in an increased PRL level [ 25 ]. Reduced libido, polyuria, polydipsia, cold intolerance, and amenorrhea are the most common indications of impaired endocrine function. Growth hormone deficiency is reported as the earliest symptom, followed by deficiencies in follicle-stimulating hormone/luteinizing hormone, thyroid-stimulating hormone, and adrenocorticotrophic hormone [ 26 ].

Pathogenesis

The direct spread or hematogenous dissemination of sphenoid sinusitis may play a role in the pathogenesis, which is the most commonly reported mechanism of abscess formation [ 27 ]. Kroppenstedt reported a close association between PA formation and blood circulation disorders, as well as tumor necrosis resulting from systemic or regional immune dysfunction [ 28 ]. Some believe that a sterile abscess may result from invasive pituitary necrosis, liquefaction of atypical pituitary cyst contents, or an atypical pituitary cyst [ 29 ]. Others argue that it may be attributed to inadequate bacteriological technique or antibiotic therapy before or during surgery [ 30 ]. Positive results for microorganisms are occasionally observed in PA, with gram-positive organisms, typically cocci, such as Staphylococcus or Streptococcus species, being the most common. Gram-negative or coliform bacteria, such as Neisseria, E. coli , and Corynebacteria , as well as uncommon organisms like fungi and parasites, constituted a small proportion [ 31 ]. Histopathological examination of PA specimens often reveals several inflammatory cells, including neutrophils, lymphocytes, and plasma cells, which could simulate the infection process and accompany the abscess formation [ 32 ].

Radiographic studies

Imaging is a valuable diagnostic tool for PA. CT scans and skull radiographs are nonspecific. Skull radiographs may reveal enlargement of the sella, erosion of the sellar floor, and opacity of the sphenoid sinus. In contrast, CT scans typically reveal sellar enlargement and a low-density sellar mass with contrast enhancement [ 33 ]. Similar to pituitary adenoma, erosion and expansion are the most common findings in the sella. Diffusion-weighted imaging (DWI) may be useful for distinguishing among PA, apoplexy, and pituitary adenoma. MRI is the most effective method for the preoperative diagnosis of PA. On MRI, this mass shows typical abscess characteristics, such as a cystic or partially cystic lesion in the sellar region. It appears as a low signal on T1WI and a high signal on T2WI. After gadolinium injection, there is accentuation of the lesion's periphery, and the signal enhancement is attributed to the presence of protein. The peripheral rim enhancement is believed to be suggestive of PA, such as hyperintense ring enhancement on T1WI that may be caused by hemorrhage and necrosis on liquid with high protein content [ 34 ]. Local thickening of the pituitary stalk may also suggest the presence of PA [ 35 ]. In cases of suspected PA, hyperintense and hypointense signals from the abscess wall are more indicative.

Diagnostic quandary

Diagnosing PA is challenging and requires a comprehensive medical history, physical examination, and a high index of suspicion. Unfortunately, specific preoperative diagnostic procedures for PA are lacking. As mentioned previously, a history of meningitis, sinusitis, or sepsis may suggest the presence of PA. Rapid neurological deterioration in a patient with a sellar tumor following suspected bacteremia should raise suspicion of abscess formation. According to the literature, suspicion of PA should be raised in the presence of the following: a history of associated diseases or an unexplained elevation in blood WBC; early hypopituitarism symptoms such as DI in the absence of a saddle tumor. Widening of the sellar turcica, erosion of the sellar floor and bone, and opacity of the sphenoid sinus on skull radiograph, CT, and MRI are indicative of a peripheral ring or sellar lesion with homogeneous enhancement [ 36 , 37 ]. When assessing a patient with symptoms of hypopituitarism and a pituitary cystic mass showing heterogeneous intensity on imaging, suspicion of infection is warranted if the patient exhibits DI and amenorrhea or symptoms and signs of pituitary mass and infection. Differential diagnoses for sellar lesions include adenoma, carcinoma, arachnoids' cyst, colloid cyst, Rathke's cyst, craniopharyngioma, and metastasis. Many of these tumorous and non-tumorous lesions may mimic the clinical, endocrine, and radiographic manifestations of pituitary adenomas, complicating the differentiation between these potential etiologies. A skilled surgeon can distinguish intraoperatively between pituitary necrosis and Rathke's cyst [ 38 ].

Treatment recommendations and outcomes

Surgical drainage followed by antibiotic treatment is the recommended therapy for PA [ 3 ]. With appropriate management, the prognosis for PA is generally favorable. The transsphenoidal approach is preferred over craniotomy due to lower risks of infection spread and visual impairment, and 75% of PA patients experience complete resolution of visual abnormalities following TSS. All patients underwent surgery via endoscopic endonasal transsphenoidal approach. Although surgery cannot completely remove the abscess, it prevents its spread to the subarachnoid space, reduces postoperative infection rate and mortality, and shortens operation time and hospital days [ 39 ]. The mortality rate has been reduced to 8.3% by early diagnosis and aggressive antibiotic treatment [ 1 ]. If there is a strong suspicion of the diagnosis, empirical antibiotics should be promptly initiated, adjusted after identifying the focus, and continued for 2–6 weeks. In our clinical practice, we would like to use gentamicin to flush rather than vancomycin during our surgery. Ceftriaxone can be used for empirical treatment first, and then replaced with sensitive antibiotics when microbiological and histological evidence is available. Antibiotics were stopped after complete resolution of the infection. Ciappetta used TSS to eliminate the abscess, triiodomethane gauze to drain pus, and antibiotics for 3 weeks postoperatively to achieve a favorable outcome [ 40 ]. According to the literature, more than 60% of patients fully recovered, 30% showed improvement in hormonal or visual impairments, and approximately 10% died after surgical and medical treatment [ 41 ] . Vates reported that approximately 54.2% of patients suffered from endocrine dysfunction before surgery, of whom 38.5% did not improve postoperatively without developing a new pituitary dysfunction [ 42 ]. In comparison, two of our patients experienced a recurrence. The recurrence rate in our cohort was not particularly low. The recurrence rate in the Vates series was 18.8%, in the Liu series was 13.3%, and other studies have reported similar rates [ 39 , 40 , 41 , 42 ]. Some may considered that the majority of recurrences were in middle-aged female patients with immunological system disorders or with previous surgery, however, further research is needed.

The prognosis is favorable with appropriate treatment, including surgery, antibiotics, and hormone replacement therapy. Complete eradication of PA is the primary objective. All pus should be thoroughly drained during the procedure, and the abscess should be irrigated with gentamicin and saline solution repeatedly. It is essential to protect normal pituitary tissue and prevent damage to the sellar diaphragm to prevent cerebrospinal fluid rhinorrhea and intracranial infection. Evaluate the abscess cavity if a pituitary adenoma is present [ 8 ]. Pus collected during surgery must undergo routine microbiological analysis. Ciappetta reported that the combined mortality rate of PA and meningitis was 28%, which rose to 50% when combined with a large sellar tumor [ 43 ]. Among these patients, 12.5% died due to new endocrine dysfunction associated with their PA, 62.5% experienced persistent pituitary dysfunction necessitating long-term hormone replacement therapy, and 25% fully regained their endocrine function.

PA is a rare but potentially life-threatening condition. Key aspects of managing PA include early diagnosis through effective TSS, rational antibiotic therapy, appropriate symptomatic treatment, and long-term follow-up. To prevent the spread of infection and the recurrence of abscesses, high-dose antibiotic therapy is necessary both before and after surgery. Although several signs and symptoms may indicate PA, it is necessary to look for additional indicators to prompt preoperative diagnosis and comprehensive treatment.

Availability of data and materials

The data sets generated for this study are available on request to the corresponding author.

Abbreviations

Pituitary abscess

• Transsphenoidal surgery

Computed tomography

Magnetic resonance imaging

T1-weighted images

T2-weighted images

Ante meridiem

Post meridian

Diabetes insipidus

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Acknowledgements

We acknowledge the collaborative support of the endocrinologists, pathologists, radiologists, and anesthesiologists in our center. We also acknowledge the seminal contributions to this study by our mentors and colleague.

This work was supported by the National Natural Science Foundation of China (Grants 81671227, 81671201).

Author information

Qiang Xue, Xiuhua Shi and Xiaoling Fu contributed equally to this study.

Authors and Affiliations

Departments of Neurosurgery, The Third Affiliated Hospital, Naval Medical University, Shanghai, 200438, China

Qiang Xue, Yating Yin & Hua He

Department of Radiotherapy & Oncology, The No. 2 People’s Hospital of Wuhu City, Wuhu, Anhui, China

Department of Medical Psychology, The Fourth Medical Center of PLA General Hospital, 51 Fu Cheng Road, Beijing, 100048, China

Xiaoling Fu

Department of Radiology, Xiangya Hospital, Central South University, Changsha, China

Department of Medical Engineering, Third Affiliated Hospital of Navy Military Medical University, Shanghai, 200438, China

Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Rui Jin Er Road, Shanghai, 200025, China

Qingfang Sun & Liuguan Bian

Institute of Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai, China

Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China

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Contributions

Conceptualization, HH; Data curation, HH and QX; Formal analysis, QX and XF; Funding acquisition, LB and YY; Investigation, QX, YY, HZ and HT; Methodology, LB, HZ and HT; Project administration, QS; Resources, SL and JM; Supervision, SL; Writing—original draft, QX, HT and HH; Writing—review and editing, HH.

Corresponding authors

Correspondence to Liuguan Bian , Hong Tan or Hua He .

Ethics declarations

Ethics approval and consent to participate.

The study was approved by the ethics committee of the Shanghai Ruijin Hospital, the ethics committee of Shanghai Changzheng Hospital, and the ethics committee of Hunan Xiangya Hospital. Informed written consent for study participation was obtained from all patients.

Competing interests

No competing financial interests exist.

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Xue, Q., Shi, X., Fu, X. et al. Pituitary abscess: a descriptive analysis of a series of 19 patients—a multi-center experience. Eur J Med Res 29 , 262 (2024). https://doi.org/10.1186/s40001-024-01749-z

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Received : 15 May 2023

Accepted : 26 February 2024

Published : 02 May 2024

DOI : https://doi.org/10.1186/s40001-024-01749-z

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