Primary Pituitary Tuberculosis Revisited

Abstract

Patient: Female, 45Final Diagnosis: Primary pituitary tuberculosisSymptoms: Headache • vomiting • vomitingMedication: —Clinical Procedure: Pituitary biospySpecialty: Endocrinology and MetabolicObjective:Rare diseaseBackground:Primary pituitary tuberculosis (in absence of other organ involvement and constitutional symptoms) is an extremely rare disease with total reported cases in the literature fewer than a hundred. Misdiagnosis as pituitary adenoma is common and late diagnosis can result in a permanent endocrine dysfunction and/or long-term neurologic sequelae.Case Report:We report on the case of a middle-aged woman who presented with severe headache and left third cranial nerve palsy. Magnetic resonance imaging (MRI) revealed a large pituitary tumor invading the left cavernous sinus. The case was initially misdiagnosed as pituitary adenoma. A pituitary biopsy was performed and was suggestive of pituitary tuberculosis. Extensive radiologic investigations did not reveal any evidence of other organ involvement by tuberculosis. She was successfully treated with anti-tuberculous medications.Conclusions:In areas with a high pre-test probability of tuberculosis, pituitary tuberculosis should be included in the differential diagnosis of pituitary tumors in order to avoid unnecessary surgical interventions. Besides being the first histologically-proven primary pituitary tuberculosis case reported from Qatar, the current case is unique in that extensive radiologic investigations did not reveal any evidence of other systemic or pulmonary tuberculosis.

Primary pituitary tuberculosis

“…4 The hematogenous spread and extension from tubercular infection of paranasal sinuses have been suggested in the literature. 3 However, the route of primary pituitary infection by the TB bacilli is still unclear. 3 Headache, visual disturbances, low-grade fever, and vomiting are common clinical symptoms.…”

“…3 However, the route of primary pituitary infection by the TB bacilli is still unclear. 3 Headache, visual disturbances, low-grade fever, and vomiting are common clinical symptoms. 3,6 Endocrine symptoms such as galactorrhea & amenorrhea are seen in females.…”

“…1,2 TB can involve any human organ or body part; however, the lungs are predominantly involved. 3 Extrapulmonary TB can occur with or without pulmonary TB and comprises 14% of the cases reported in 2017 globally. 1,3,4 TB of the central nervous system (CNS) constitutes only 1% of the TB cases globally and is more common in areas with high TB prevalence rate.…”

“…3 Extrapulmonary TB can occur with or without pulmonary TB and comprises 14% of the cases reported in 2017 globally. 1,3,4 TB of the central nervous system (CNS) constitutes only 1% of the TB cases globally and is more common in areas with high TB prevalence rate. 3,4 CNS TB can involve the meninges, brain, or adjacent bone by the hematogenous spreading of the infection.…”

“…1,3,4 TB of the central nervous system (CNS) constitutes only 1% of the TB cases globally and is more common in areas with high TB prevalence rate. 3,4 CNS TB can involve the meninges, brain, or adjacent bone by the hematogenous spreading of the infection. 4 Primary pituitary gland TB is a sporadic condition, and only <110 cases have been reported till now.…”