Intrasellar tuberculoma

Abstract

Although intrasellar tuberculomas have been reported in post-mortem examinations, they are exceptionally rare in clinical practice. Five patients with biopsy proven intrasellar tuberculoma with suprasellar extension are described. In four cases the clinical and radiological diagnosis was that of a pituitary adenoma. One patient, however, presented similar to a subarachnoid haemorrhage, but the CSF analysis was suggestive of tuberculous meningitis. All these patients presented either with intermittent headache or a sudden severe headache suggestive of an ictus. Hypopituitarism was diagnosed on clinical grounds in two patients and one patient had an associated galactorrhoea-amenorrhoea syndrome. Only one patient had a bitemporal field cut. In all other patients ophthalmological examination was normal. The CT scan showed a hyperdense sellar mass with suprasellar extension brightly enhancing with contrast in all cases. An angiogram in four patients did not reveal any vascular lesion. Laboratory investigation showed some degree of hypopituitarism in all cases. Transsphenoidal surgery was performed in four patients and operative findings were typical, and unlike those of a pituitary adenoma. All patients responded well to antituberculous treatment and at the end of 12 months were clinically and radiologically normal.

Reversible Hypopituitarism with Pituitary Tuberculoma

“…Among the 22 reported cases, only one patient was negative for this finding; however, it is a nonspecific finding that also occurs in other conditions, such as sarcoidosis, lymphocytic hypophysitis and Langerhans cell histiocytosis. Hypopituitarism is observed in 22-40% of intrasellar tuberculoma patients (8,9). Among the 22 cases described above, eight patients had hypopituitarism (Table 5).…”

“…In Japan, which is now a developed country, tuberculosis remains more prevalent than in Europe and America. However, there are limited case reports of intracranial tuberculoma as well as two integrative reports of intrasellar tuberculoma (8,9). Hence, pituitary tuberculoma is an extremely rare disease.…”

Endocrine and Metabolic Aspects of Tuberculosis

“…Skull films may demonstrate calcifications in the region of the sella turcica (75,76). Appearance on CT or MRI suggests intrasellar tumor, and angiography results are normal (69,70,79). In some cases, thickening of the pituitary stalk, with or without pituitary extension into the sphenoid sinus, may be noted on CT or MRI (74,80,81).…”

“…Patients may be relatively asymptomatic, and the endocrine abnormalities may be subtle and noted only on detailed investigation. Any portion of the pituitary (including anterior, posterior, and the stalk) or the hypothalamus can be involved; consequently, presentations can vary and include growth retardation, hypogonadism, galactorrhea-amenorrhea related to excess prolactin secretion, diabetes insipidus, and even panhypopituitarism (68,(70)(71)(72)(73)(74).…”

“…Patients may experience symptoms related to pituitary enlargement, including headache and visual complaints, with or without selective hypopituitarism (69)(70)(71). Sometimes, selective hypopituitarism occurs in the absence of other symptoms (72).…”