Clinicoradiological presentation, management options and a review of sellar and suprasellar tuberculomas

Behari, Sanjay; Shinghal, Udit; Jain, Manoj; Jaiswal, Awadhesh Kumar; Wadwekar, Vaibhav; Das, KuntalKanti; Jha, Sanjeev

doi:10.1016/j.jocn.2008.12.032

Cited by 33 publications

(41 citation statements)

References 26 publications

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“…Preoperatively, a Rathke’s cleft cyst, a cystic pituitary adenoma, a craniophagyngioma, a metastatic tumor, or inflammatory disease was suspected from MRI findings. Although previous papers reported a thickening of pituitary stalk and involvement with paranasal sinus or clivus as relatively common MRI findings of sellar tuberculomas, 1,4,6,7,10) these findings were not confirmed in our case. Thus, the intraoperative pathological diagnosis indicating the tuberculous lesion surprised us.…”

Section: Discussioncontrasting

confidence: 96%

“…1–10) However, the development of drugs and improvement of socioeconomic conditions have reduced the frequency of intracranial tuberculomas, which constitute only 0.5–4% of all intracranial space-occupying lesions. 1–4,10,11) Intracranial tuberculomas are commonly located in the cerebellum and cerebral cortex, 12) and pituitary tuberculomas are extremely rare. 1,2,4–7,10,11) Indeed, almost all previous reports of pituitary tuberculomas are from developing countries.…”

Section: Introductionmentioning

confidence: 99%

“…1–4,10,11) Intracranial tuberculomas are commonly located in the cerebellum and cerebral cortex, 12) and pituitary tuberculomas are extremely rare. 1,2,4–7,10,11) Indeed, almost all previous reports of pituitary tuberculomas are from developing countries. 1–7,9,10) However, with the increasing incidence of immuno-compromised adults with acquired immune deficiency syndrome (AIDS), diabetes mellitus, or malignancy, or who are undergoing immune-suppressive treatment, there is likely to be a concurrent global increase of pituitary tuberculomas in developed countries.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,4–7,10,11) Indeed, almost all previous reports of pituitary tuberculomas are from developing countries. 1–7,9,10) However, with the increasing incidence of immuno-compromised adults with acquired immune deficiency syndrome (AIDS), diabetes mellitus, or malignancy, or who are undergoing immune-suppressive treatment, there is likely to be a concurrent global increase of pituitary tuberculomas in developed countries. 12,13) Here, we report quite a rare case of pituitary tuberculoma mimicking a pituitary adenoma or a Rathke’s cleft cyst in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Isolated Pituitary Tuberculoma

Saito¹,

Toda²,

Shido³

et al. 2014

NMC Case Report Journal

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Pituitary tuberculomas are extremely rare, even in the developing countries where tuberculosis is endemic. We report a rare case of isolated pituitary tuberculoma mimicking a pituitary adenoma or a Rathke’s cleft cyst in Japan, a developed country. The patient was a 69-year-old woman presented with visual disturbance. Head magnetic resonance imaging (MRI) with contrast enhancement revealed an isolated intrasellar mass showing central hypointensity with an irregularly enhancing rim. She was operated on via an endoscopic transsphenoidal approach. Histopathological findings and an interferon-gamma release assay were highly suspicious of an isolated tuberculous granuloma. After proper infection control management, she was treated with four-drug antituberculous therapy (ATT). Follow-up MRI showed no recurrence 3 years after the discontinuation of ATT. An isolated pituitary tuberculoma has rarely been reported, especially in developed countries. In conclusion, neurosurgeons should consider an isolated pituitary tuberculoma as one of the differential diagnoses for pituitary tumors, because special management for infection control is required for tuberculosis. An interferon-gamma release assay is helpful for the difficult diagnosis of an isolated pituitary tuberculoma with inactive tuberculosis.

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Section: Discussioncontrasting

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Isolated Pituitary Tuberculoma

Saito¹,

Toda²,

Shido³

et al. 2014

NMC Case Report Journal

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“…[6] However, in cases with tuberculoma of the pituitary gland, the most frequent deficiencies encountered are ACTH, thyroid stimulating hormone (TSH), and hyperprolactinemia. [78]…”

mentioning

confidence: 99%

Pituitary dysfunction in infective brain diseases

Beatrice

Selvan

Mukhopadhyay

2013

Indian J Endocr Metab

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Infectious diseases of the central nervous system (CNS) are increasingly being recognized as important causes of hypopituitarism. Although tuberculosis is the most common agent involved, non-mycobacterial agents like viruses, bacteria, fungus, and protozoa are important causes in our country. Involvement post infections could be due to a strategically located tuberculoma, or pituitary abscess, or meningoencephalitis. Although it might not be reasonable to screen all patients with CNS infections for hypopituitarism, awareness of the possibility and clinical follow-up for suggestive symptoms is required.

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