Krishnan Gaayathri, Mohd Makhatar Nur Hidayah, Ching Tee Hwee, Khoo Serena
Endocrinology Unit, Department of Internal Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Endocrinol Diabetes Metab Case Rep. 2024 Jan 29;2024(1). doi: 10.1530/EDM-23-0092. Print 2024 Jan 1.
Pituitary tuberculoma is extremely rare and may pose as a diagnostic challenge especially when encountered as an isolated lesion without other systemic manifestation of tuberculosis. A 21-year-old female was admitted for diabetic ketoacidosis. On the third day of admission following the resolution of diabetic ketoacidosis she developed a sudden onset of headache and blurring of vision suggestive of pituitary apoplexy. An urgent MRI brain revealed a large sellar mass with erosion into the sphenoid sinus and intracranial vasculitis. Transphenoidal surgery was done for tumour debulking which allowed histopathological examination of the sellar mass. Immunohistochemical examination of the sellar mass was positive for Gene Xpert MTB/Rif suggesting a tuberculoma. Anti-tuberculous therapy was commenced with full recovery of pituitary hormonal profile seen 7 months post-treatment. In regions with a high incidence of tuberculosis, a tuberculoma should be a considered in a diagnostic evaluation of a sellar lesion.
In an endemic area of tuberculosis, tuberculoma should be considered as a differential diagnosis when evaluating sellar lesions. Pituitary tuberculoma can present with pituitary apoplexy-like symptoms. Prompt diagnosis and treatment may lead to recovery of pituitary function.
垂体结核瘤极为罕见，尤其是在作为孤立病变且无其他结核病全身表现时，可能构成诊断挑战。一名21岁女性因糖尿病酮症酸中毒入院。在糖尿病酮症酸中毒缓解后的入院第三天，她突然出现头痛和视力模糊，提示垂体卒中。紧急脑部MRI显示鞍区有一巨大肿块，侵犯蝶窦并伴有颅内血管炎。行经蝶窦手术切除肿瘤以减轻肿瘤负荷，从而对鞍区肿块进行组织病理学检查。鞍区肿块的免疫组化检查Gene Xpert MTB/Rif呈阳性，提示为结核瘤。开始抗结核治疗，治疗7个月后垂体激素水平完全恢复。在结核病高发地区，诊断鞍区病变时应考虑结核瘤。
在结核病流行地区，评估鞍区病变时应将结核瘤作为鉴别诊断之一。垂体结核瘤可表现为垂体卒中样症状。及时诊断和治疗可能使垂体功能恢复。
