Silent Pituitary Tuberculoma Associated with Pituitary Adenoma

An Unusual Association of Acromegaly and Pituitary Tuberculosis

“…Even though, in our patient there was necrotizing granulomatous inflammation and multiple epithelioid cell granulomas with multinucleated giant cells consistent with tuberculoma in pituitary tissues, however acid-fast bacilli could not be demonstrated in the lesion. It is uncommon to isolate the organism in tuberculomas as reported in earlier case studies as well [4,5]. In addition, retroperitoneal lymphnode biopsy showed multiple caseating granulomas which were consistent with tuberculosis and the disappearance of retroperitoneal lymphnode with ATT further supports the diagnosis of tuberculosis.…”

“…There is scanty literature pertaining to intrasellar tuberculoma and concomitant pituitary adenoma. To our knowledge, only two cases of coexisting pituitary adenoma and intrasellar tuberculoma have been reported previously [4,5].…”

Isolated intrasellar tuberculoma mimicking pituitary adenoma

“…Even if suggestive of a tuberculoma, these are not conclusive, as often the case with granulomatous lesions (Table 1). 13,14 A female predominance is reported. 11,13 The absence of bacteria in CSF and the specimen, does not exclude tuberculoma.…”

“…6-8 A range of diagnostic procedures including a transsphenoidal biopsy are necessary to provide an accurate diagnosis, which, in the case of infectious or inflammatory etiology, may lead to an efficient medical therapy. 5,11,[13][14][15]17,18,[23][24][25][26] To the best of our knowledge, only one case of isolated intrasellar tuberculoma with pituitary insufficiency has been reported. MRI did not rule out pituitary adenoma.…”

Pituitary Adenoma with Tumoral Granulomatous Reaction

“…Tuberculomas not only mimic pituitary adenoma but have been reported to undergo apoplexy, even more closely mimicking tumor at presentation [30]. On rare occasion, an intrasellar tuberculoma, albeit separate and discrete, coexists with a pituitary adenoma [13,31,32].…”