1
|
Kumar T, Nigam JS, Jamal I, Jha VC. Primary pituitary tuberculosis. AUTOPSY AND CASE REPORTS 2020; 11:e2020228. [PMID: 34277492 PMCID: PMC8101658 DOI: 10.4322/acr.2020.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis is an infectious disease that involves any organ. However, the primary pituitary tuberculosis is an extremely rare disease. Intracranial tuberculomas account for 0.15-5% of intracranial space-occupying lesions, of which, pituitary as the primary site is unusual, and easily misdiagnosed as pituitary adenoma. In this setting, the late diagnosis can result in permanent endocrine dysfunction. We report the case of a 50-year-old woman who presented to the neurosurgery outpatient department with complaints of progressively increasing headache and diminished vision over the last year. On the clinical examination, the patient was conscious and oriented. The routine hematological and biochemical workup showed an increased erythrocyte sedimentation rate (ESR) and increased prolactin levels. The radiological working diagnosis was consistent with pituitary macroadenoma. No other radiological and/or clinical clue that could elicit the suspicion of pulmonary or extrapulmonary lesions of tuberculosis was found. The transsphenoidal endonasal tumor excision was done. The histopathology showed numerous epithelioid cell granulomas, Langhans giant cells along with scant necrosis. Ziehl Neelsen staining demonstrated acid-fast bacilli, and the final diagnosis of pituitary tuberculoma was made. We report this rare case of pituitary lesion that may be included in the differential diagnosis of sellar lesions to avoid unnecessary surgical interventions, especially in regions where the disease is endemic.
Collapse
Affiliation(s)
- Tarun Kumar
- All India Institute of Medical Science, Department of Pathology, Patna, Bihar, India
| | - Jitendra Singh Nigam
- All India Institute of Medical Science, Department of Pathology, Patna, Bihar, India
| | - Iffat Jamal
- Indira Gandhi Institute of Medical Sciences, Department of Hematology, Patna, Bihar, India
| | - Vikas Chandra Jha
- All India Institute of Medical Science, Department of Neurosurgery, Patna, Bihar, India
| |
Collapse
|
2
|
Majumdar K, Barnard M, Ramachandra S, Berovic M, Powell M. Tuberculosis in the pituitary fossa: a common pathology in an uncommon site. Endocrinol Diabetes Metab Case Rep 2014; 2014:140091. [PMID: 25535577 PMCID: PMC4256724 DOI: 10.1530/edm-14-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/12/2014] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is an important cause of mortality and morbidity across the world. In 2–5% of all cases of systemic TB, the C is affected, with lesions reported in the meninges, cortex and ventricles. Intrasellar tuberculomas, however, are extremely rare. We report the interesting case of a young female patient who presented with secondary hypothyroidism and hyperprolactinaemia. She was treated successfully for pituitary TB. We also highlight and discuss some interesting (and hitherto unreported) endocrine issues. Radiological and histological features and treatment of pituitary TB are discussed using this case as an example.
Collapse
Affiliation(s)
- K Majumdar
- University College London Hospitals NHS Foundation Trust , Diabetes and Endocrinology , 9 Hiller Close, London , UK
| | | | | | | | - M Powell
- National Hospital for Neurology and Neurosurgery , London , UK
| |
Collapse
|
3
|
Clinical presentation and magnetic resonance findings in sellar tuberculomas. Case Rep Med 2014; 2014:961913. [PMID: 25114688 PMCID: PMC4119910 DOI: 10.1155/2014/961913] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/31/2014] [Indexed: 11/17/2022] Open
Abstract
Background and Importance. Sellar tuberculomas are extremely rare lesions with nonspecific clinical manifestations. The tuberculous infection of the pituitary gland and sellar region is characterized by the presence of an acute or chronic inflammatory reaction and may occur in the absence of systemic tuberculosis. The diagnosis is difficult prior to the surgery. An adequate diagnostic and antituberculous drugs usually result in a good outcome. Clinical Presentation. We report four cases of sellar tuberculoma, 3/1 female/male, age range: 50–57 years. All patients had visual disturbances and low levels of cortisol. Conclusion. The clinical diagnosis of sellar tuberculoma is a challenge and should be suspected when a sellar lesion shows abnormal enhancement pattern and stalk involvement, and absence of signal suppression in FLAIR.
Collapse
|
4
|
Psimaras D, Bonnet C, Heinzmann A, Cárdenas G, Hernández José Luis S, Tungaria A, Behari S, Lacrois D, Mokhtari K, Karantoni E, Sokrab Tag E, Idris Mohamed N, Sönmez G, Caumes E, Roze E. Solitary tuberculous brain lesions: 24 new cases and a review of the literature. Rev Neurol (Paris) 2014; 170:454-63. [DOI: 10.1016/j.neurol.2013.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/11/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
|
5
|
Kidd D. The optic chiasm. Clin Anat 2014; 27:1149-58. [PMID: 24824063 DOI: 10.1002/ca.22385] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/22/2014] [Accepted: 02/01/2014] [Indexed: 11/08/2022]
Abstract
The optic chiasm is formed when the optic nerves come together in order to allow for the crossing of fibers from the nasal retina to the optic tract on the other side. This enables vision from one side of both the eyes to be appreciated by the occipital cortex of the opposite side. This review makes note of the embryology, anatomy and vascular supply of the optic chiasm, then discusses the clinical syndromes associated with chiasmal disease, and the diseases which commonly influence its function.
Collapse
Affiliation(s)
- Desmond Kidd
- Department of Neuro-Ophthalmology, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom; University College Hospital Medical School, United Kingdom
| |
Collapse
|
6
|
Abstract
In the first part of this chapter the anatomy and vascular supply of the chiasm are recounted, and the visual symptoms that may arise in chiasmal disease are noted. The neuro-ophthalmic signs, including the pattern of visual field defects, appearance of the optic disc, and various uncommon clinical accompaniments, are described. The second part deals with a comprehensive list of disease processes that may directly or indirectly affect the chiasm. These are divided into inflammatory disorders, including sarcoidosis, multiple sclerosis, and idiopathic chiasmitis; infective disorders, including tuberculosis; and a large section on tumors, including pituitary adenomas, cysts, and choristomas, malignant disorders, including germ cell tumors and glioma, and meningioma; and finally vascular disorders and compression due to hydrocephalus. In each case the clinical features and management of the disorder are noted, as well as the prognosis for visual improvement following treatment.
Collapse
Affiliation(s)
- Desmond Kidd
- Department of Neuro-ophthalmology, Royal Free Hospital and Royal Free and University College Hospital Medical School, London, UK.
| |
Collapse
|
7
|
Furtado SV, Venkatesh PK, Ghosal N, Hegde AS. Isolated sellar tuberculoma presenting with panhypopituitarism: clinical, diagnostic considerations and literature review. Neurol Sci 2010; 32:301-4. [PMID: 20886253 DOI: 10.1007/s10072-010-0409-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 09/01/2010] [Indexed: 11/28/2022]
Abstract
Tuberculosis, a common cause for chronic intracranial infections can mimic varied intracranial pathologies including tumours. Pituitary tuberculomas are rare lesions and are often diagnosed pre-operatively as pituitary tumours. We report a case of a 31-year-old lady with a sellar-suprasellar lesion who presented with panhypopituitarism. The patient underwent a trans-nasal, trans-sphenoidal surgical decompression of the lesion. Histopathology revealed a tuberculous lesion in the pituitary. The characteristic radiological features of sellar tuberculomas are discussed along with a review of literature. Atypical sellar radiology in the presence of a thickened pituitary stalk could point to pathology other than pituitary adenoma, possibly a chronic inflammatory condition like tuberculoma.
Collapse
Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, 560066, Karnataka, India.
| | | | | | | |
Collapse
|
8
|
Clinicoradiological presentation, management options and a review of sellar and suprasellar tuberculomas. J Clin Neurosci 2009; 16:1560-6. [DOI: 10.1016/j.jocn.2008.12.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 11/29/2008] [Accepted: 12/07/2008] [Indexed: 11/19/2022]
|
9
|
Rousset P, Cattin F, Chiras J, Bonneville JF, Bonneville F. [Diagnostic significance of T2W hypointensity of the sella]. ACTA ACUST UNITED AC 2009; 90:693-705. [PMID: 19623122 DOI: 10.1016/s0221-0363(09)74724-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Normal anatomical structures and lesions characterized by low T2W signal intensity are reviewed in this pictorial essay. The purpose is to demonstrate how evaluation of the appearance, shape and exact anatomical location of the T2W hypointense sellar region structure, correlated with its T1W signal intensity, can based on the clinical context lead to an appropriate differential diagnosis.
Collapse
Affiliation(s)
- P Rousset
- Service de neuroradiologie, Groupe hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris.
| | | | | | | | | |
Collapse
|
10
|
Trabelsi L, Mnif M, Rekik N, Kaffel N, Charfi N, Mnif J, Kchaow MS, Abid M. Anomalies de la tige pituitaire à l’IRM : aspects étiologiques à propos de 11 cas. ANNALES D'ENDOCRINOLOGIE 2006; 67:604-12. [PMID: 17194972 DOI: 10.1016/s0003-4266(06)73014-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Newer techniques of magnetic resonance imaging (MRI) describe more accurately pituitary stalk abnormalities such as infections, infiltrative lesions and tumors. In absence of all the above mentioned etiological factors, genetics defects are suspected, mainly when other malformations are equally present. We attempt to show through 11 observations the variability of pathologies involving the pituitary stalk with their respective clinical and radiological features and associated endocrine abnormalities. This is a retrospective study of 7 men (67%) and 4 women (33%), mean age of 28 year (range: 15 to 53) in whom pituitary MRI was performed for hypopituitarism, diabetes insipidus or hyperprolactinemia. Three patients had brain MRI for an extra-pituitary condition. The pituitary MRI showed a stalk section in 3 cases (27%), atrophy in 1 case and thickening in 7 cases (67%). The pituitary stalk anomaly was associated with hyperprolactinemia in 3 cases (27%), central diabetes insipidus in 4 cases (36%), growth hormone deficiency in 4 cases (36%), adrenal insufficiency in 5 cases (45%), hypogonadism in 5 cases (45%) and hypothyroidism in one case (9%). Established diagnoses were: sellar metastasis in 2 cases (18%), Langerhans' histocytosis, tuberculosis and autoimmune hypophysitis respectively in 3 cases (9%). In 6 cases (54%), no clear etiology was found. Given the multitude of pituitary stalk pathologies, a detailed etiologic inquiry must be performed in order to detect elements able to reclassify an initially idiopathic disorder.
Collapse
Affiliation(s)
- L Trabelsi
- Service d'Endocrinologie, CHU Hédi Chaker, Sfax, 3029 Tunisia.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Trabelsi L, Majdoub-Rekik N, Bouaziz H, Mnif-Feki M, Hammemi B, Maaloul I, Ben Jmaa M, Abid M. [Pituitary tuberculosis: a case report]. ANNALES D'ENDOCRINOLOGIE 2006; 66:340-6. [PMID: 16392184 DOI: 10.1016/s0003-4266(05)81791-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Through a case of sellar and suprasellar tuberculoma which presented with central diabetes insipidus, the authors report the frequency of pituitary tuberculoma, its physiopathology, clinical presentation hormonal and radiological findings thus management and evolution. A 42 years old woman, with a history of erythema nodosum, presented with polyuria polydipsia (PUPD), amenorrhea and galactorrhea. Endocrine investigations showed central diabetes insipidus, elevated serum prolactin levels and cortisol failure. Magnetic resonance imagining scans (MRI) revealed a nodular thickening of the pituitary enlargement and loss of posterior pituitary hypointensity signal. Etiologic inquiry has removed the diagnosis of sarcoidosis, Langerhan's histosis, autoimmune hypophysitis and sellar metastasis. The history of erythema nodosum, the positivity of tuberculin skin test and the presence of koch bacillus in the bronchial fluid after culture led to a diagnosis of tuberculosis. Treatment was started with four drug antitubercular chemotherapy regimen for 2 months, and tow drug antitubercular chemotherapy regimen for 16 months. This treatment is associated with hydrocortisone, desmopressin nasal spray and bromocriptine. Under treatment, there was an improvement in clinical condition, disapearence of headache, PUPD and galactorrhea thus normalization of prolactin. A follow-up MRI, 8 months later, showed that pituitary lesion has been completely removed, suggesting our clinical and biology presumption. Pituitary tuberculosis is rare, however, when encountered, they may present a diagnostic difficulty. Accurate diagnosis and management is important because pituitary tuberculoma is curable.
Collapse
Affiliation(s)
- L Trabelsi
- Service d'Endocrinologie, CHU Hédi Chaker, Sfax, Tunisie
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Mistr S, Chavis PS. Treatment of neuro-ophthalmologic manifestations of tuberculosis. Curr Treat Options Neurol 2005; 8:53-67. [PMID: 16343361 DOI: 10.1007/s11940-996-0024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the absence of obvious pulmonary or disseminated tuberculosis, ocular and central nervous system (CNS) tuberculosis may represent a significant diagnostic challenge. Refinements in polymerase chain reaction techniques and neuroimaging have strengthened the battery of tests used to diagnose CNS and ocular tuberculosis, yet in many cases, the diagnosis remains one of exclusion; it may ultimately be determined through exacerbation by anti-inflammatory therapy with subsequent improvement by antitubercular medication treatment. Because of emerging drug resistance, at least a two-drug regimen is required for therapeutic testing and treatment of isolated ocular tuberculosis. If pulmonary or miliary disease coexists, a 6-month, four-drug regimen with isoniazid, rifampin, pyrazinamide, and ethambutol is required for treatment. Tubercular meningitis is treated with the same four-drug regimen for at least 9 to 12 months. Burden of therapeutic compliance rests on the treating physician and public health sector. Best compliance is realized with directly observed therapy.
Collapse
Affiliation(s)
- Susannah Mistr
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, Charleston, SC 29425, USA
| | | |
Collapse
|
13
|
Abstract
Inflammatory and infectious diseases of the pituitary gland are rare, and imaging diagnosis may be difficult. They encompass a wide spectrum of pathology including autoimmune (lymphocytic) hypophysitis, granulomatous hypophysitis, local manifestations of systemic disease, and a multitude of infectious processes. Based on extensive review of the literature, this article will present a classification scheme, description of pathology, and imaging findings of the various inflammatory and infectious entities, along with selected images from our case material.
Collapse
Affiliation(s)
- Kenneth M Lury
- University of North Carolina School of Medicine, Department of Radiology, Chapel Hill, NC 27599-7510, USA.
| |
Collapse
|