Majumdar K, Barnard M, Ramachandra S, Berovic M, Powell M
University College London Hospitals NHS Foundation Trust , Diabetes and Endocrinology , 9 Hiller Close, London , UK.
Whittington Hospital , London , UK.
Endocrinol Diabetes Metab Case Rep. 2014;2014:140091. doi: 10.1530/EDM-14-0091. Epub 2014 Dec 1.
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.
Intrasellar TB continues to be a rare presentation, but incidence and prevalence are expected to grow with increasing numbers of multidrug-resistant TB and shrinking geographical boundaries across the world.Pituitary TB can present with features of a typical adenoma, but has certain radiological and histological features that help to differentiate from an adenoma.Patients can present with a variety of endocrine abnormalities at different times.The presence of an intrasellar mass in individuals at a high risk of developing TB, or with a previous history of systemic TB, should prompt the diagnosis of pituitary TB. In such individuals, it may be worth considering a trial of anti-tuberculous therapy, before considering surgery.
结核病是全球范围内导致死亡和发病的重要原因。在所有系统性结核病病例中，有2% - 5%的病例累及中枢神经系统（C），病变见于脑膜、皮质和脑室。然而，鞍内结核瘤极为罕见。我们报告了一例年轻女性患者的有趣病例，该患者表现为继发性甲状腺功能减退和高泌乳素血症。她的垂体结核得到了成功治疗。我们还强调并讨论了一些有趣的（以及迄今未报道的）内分泌问题。以该病例为例，讨论了垂体结核的放射学和组织学特征及治疗方法。
鞍内结核仍然是一种罕见的表现，但随着耐多药结核病数量的增加以及全球地理界限的缩小，其发病率和患病率预计将会上升。垂体结核可表现出典型腺瘤的特征，但具有某些有助于与腺瘤相鉴别的放射学和组织学特征。患者在不同时间可出现多种内分泌异常。在有患结核病高风险或有系统性结核病史的个体中，若发现鞍内肿块，应考虑垂体结核的诊断。在此类个体中，在考虑手术之前，不妨先试行抗结核治疗。
