Pituitary tuberculoma masquerading as a pituitary adenoma: Interesting case report and review of literature

We present a rare case of a pituitary tuberculoma masquerading as pituitary adenoma with pituitary apoplexy-like presentation in a 31-year-old female, who had symptoms suggestive of acute secondary adrenal insufficiency with secondary amenorrhea. After initial evaluation which was suggestive of pituitary adenoma, she underwent endoscopic transnasal pituitary tumor excision. Histopathology revealed features of pituitary tuberculoma. She was subsequently started on four drug anti-tubercular therapy and is on follow-up. Although uncommon, tuberculomas, especially in the pituitary gland, are known for behaving like pituitary adenomas, by impairment of pituitary hormonal function and by exerting pressure effects on surrounding vital intracranial structures. Diagnostic challenges, treatment modality, and literature review are presented in this case report. Pituitary tuberculoma even though a rare entity should be borne in mind as a differential diagnosis in a patient manifesting with pituitary apoplexy-like syndrome.

Key-words:

Anti-tubercular therapy - hormone replacement - pituitary tuberculoma - sellar adenoma

Financial support and sponsorship

Nil.

Publikationsverlauf

Eingereicht: 28. Juli 2020

Angenommen: 06. Oktober 2020

Artikel online veröffentlicht:
16. August 2022

• References

• 1 Ayele BA, Abdinasir W, Abate B, Abdi T. Sellar tuberculoma: A rare presentation in a 30-year-old Ethiopian woman: Case report. Afr J Neurol Sci 2019;38:50-3.
• 2 Mascarenhas JV, Ayyar SV. Tuberculosis of the sella masquerading as pituitary adenoma. J Clin Sci Res 2013;2:42-4.
• 3 Srisukh S, Tanpaibule T, Kiertiburanakul S, Boongird A, Wattanatranon D, Panyaping T, et al. Pituitary tuberculoma: A consideration in the differential diagnosis in a patient manifesting with pituitary apoplexy-like syndrome. IDCases 2016;5:63-6.
• 4 Coleman CC, Meredith JM. Diffuse tuberculosis of the pituitary gland stimulating tumor, with postoperative recovery. Arch Neur Psych 1940;44:1076-85.
• 5 Kim SH, Kim DG. Sellar tuberculoma mimicking pituitary adenoma. J. Korean Neurosurg Soc 2003;34:245-8.
• 6 Rajasekaran S, Vanderpump M, Baldeweg S, Drake W, Reddy N, Lanyon M, et al. UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf) 2011;74:9-20.
• 7 Deogaonkar M, De R, Sil K, Das S. Pituitary tuberculosis presenting as pituitary apoplexy. Int J Infect Dis 2006;10:338-9.
• 8 Gupta PK, Pandey S, Pandey D. Pituitary tuberculoma: An uncommon pathology. Indian J Neurosurg 2020. DOI: https://doi.org/10.1055/s-0039-3401334.
• 9 Manghani DK, Gaitonde PS, Dastur DK. Pituitary tuberculoma–a case report. Neurol India 2001;49:299-301.
• 10 Singh S. Pituitary tuberculoma: Magnetic resonance imaging. Neurol India 2003;51:548-50.