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Raja Shariff RE, Wan Muhamad Hatta SF, Kasim S. A rare cause of acute hypernatraemia: Diabetes insipidus secondary to suprasellar tuberculoma. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/2010105820978669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Suprasellar tuberculomas are uncommon causes of intracranial tumours worldwide, even in areas endemic for tuberculosis. Often, they present with combinations of pituitary hormone involvement, which can lead to various complications due to hypopituitarism. We present a rare case of suprasellar tuberculoma leading to diabetes inspidus.
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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.
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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
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Gupta PK, Pandey S, Pandey D. Pituitary Tuberculoma: An Uncommon Pathology. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0039-3401334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractPituitary tuberculomas are extremely rare with only few cases reported in the literature. Intracranial tuberculoma commonly presents with gradual onset of headache and visual disturbances with or without systemic symptoms. We reported such a case who presented with headache without any visual symptoms, occasional vomiting, and significant weight loss. Contrast magnetic resonance imaging scan was suggestive of pituitary macroadenoma. Transnasal transsphenoidal excision of the lesion (microscopic + endoscopic) was done. Histopathological examination revealed possibility of tuberculosis. Patient was put on standard antituberculosis treatment and discharged in a stable condition.
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Affiliation(s)
- Praveen Kumar Gupta
- Department of NeuroSurgery, Sir Sunder Lal Hospital, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Sharad Pandey
- Department of NeuroSurgery, P.G.I.M.E.R., Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Deepa Pandey
- Department of Pathology and Microbiology, Northern Railway Central Hospital, New Delhi, India
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Sharma GR, Kaushal P, Vaidya B, Kumar P. Third ventricular tuberculoma mimicking as a tumor: Report of a very rare case. Asian J Neurosurg 2017; 12:58-61. [PMID: 28413535 PMCID: PMC5379806 DOI: 10.4103/1793-5482.145061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intracranial tuberculoma is a common neurosurgical problem in developing countries; however, intraventricular tuberculoma is a rare entity. Here, we report a rare case of third ventricular tuberculoma in a 21-year-old girl who presented with features of raised intracranial pressure. Radiological findings and management of third ventricular tuberculoma would be discussed and literature regarding such lesions will be reviewed.
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Affiliation(s)
- Gopal R Sharma
- Department of Neurosurgery, Om Hospital, Chabahil, Kathmandu, Nepal
| | - Prashant Kaushal
- Department of Neurosurgery, Om Hospital, Chabahil, Kathmandu, Nepal
| | - Bivek Vaidya
- Department of Neurosurgery, Om Hospital, Chabahil, Kathmandu, Nepal
| | - Pawan Kumar
- Department of Neurosurgery, Om Hospital, Chabahil, Kathmandu, Nepal
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Antony G, Dasgupta R, Chacko G, Thomas N. Pituitary tuberculoma with subsequent drug-resistant tuberculous lymphadenopathy: an uncommon presentation of a common disease. BMJ Case Rep 2017; 2017:bcr2016218330. [PMID: 28183710 PMCID: PMC5307273 DOI: 10.1136/bcr-2016-218330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/04/2022] Open
Abstract
We report a case of pituitary tuberculosis which presented as a non-functioning pituitary macroadenoma, and subsequently developed multidrug-resistant tuberculous lymphadenopathy. Pituitary tuberculosis continues to be a rare presentation of tuberculosis, but incidence and prevalence are expected to grow with increasing numbers of multidrug-resistant tuberculosis. Isolated pituitary tuberculosis is rare. Tuberculosis should be considered in the differential diagnosis in evaluation of a sellar mass.
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Affiliation(s)
- Geethu Antony
- ChristianMedical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Riddhi Dasgupta
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geetha Chacko
- ChristianMedical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
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Djoubairou BO, Gazzaz M, Hammi S, Bouya SM, Salami M, Mostarchid BE. Panhypopituitarism revealing sellar tuberculoma. ANNALES D'ENDOCRINOLOGIE 2015; 76:286-8. [DOI: 10.1016/j.ando.2015.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/16/2015] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
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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.
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Saito K, Toda M, Shido S, Tomita T, Ogawa K, Yoshida K. Isolated Pituitary Tuberculoma. NMC Case Rep J 2014; 1:33-36. [PMID: 28663950 PMCID: PMC5364942 DOI: 10.2176/nmccrj.2013-0330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/12/2014] [Indexed: 12/03/2022] Open
Abstract
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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Affiliation(s)
- Katsuya Saito
- Department of Neurosurgery, Head and Neck Surgery, Keio University School of Medicine, Tokyo
| | - Masahiro Toda
- Department of Neurosurgery, Head and Neck Surgery, Keio University School of Medicine, Tokyo
| | - Satoka Shido
- Department of Neurosurgery, Head and Neck Surgery, Keio University School of Medicine, Tokyo
| | - Toshiki Tomita
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo
| | - Kaoru Ogawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo
| | - Kazunari Yoshida
- Department of Neurosurgery, Head and Neck Surgery, Keio University School of Medicine, Tokyo
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Nayil K, Singh S, Makhdoomi R, Ramzan A, Wani A. Sellar-suprasellar tuberculomas in children: 2 cases and literature review. Pediatr Neurol 2011; 44:463-6. [PMID: 21555059 DOI: 10.1016/j.pediatrneurol.2011.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 11/16/2010] [Accepted: 01/24/2011] [Indexed: 11/26/2022]
Abstract
Sellar and suprasellar tuberculomas are rare. Patients with these lesions usually experience headache, vomiting, and hypofunction of pituitary gland; imaging reveals an enhancing sellar-suprasellar mass. We report 2 rare cases of sellar-suprasellar tuberculomas in children aged 8 and 6 years. One child presented with features of headache and vomiting, and the other presented with posterior pituitary dysfunction. In both cases, imaging revealed sellar-suprasellar masses. Both cases were multidrug-resistant tuberculomas. We discuss sellar-suprasellar tuberculomas, a rare form of neurotuberculosis in the background of an overall increase in multidrug-resistant tuberculosis, especially in children.
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Affiliation(s)
- Khursheed Nayil
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir.
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