Case Report: An Atypical Sellar Mass - Sellar Tuberculoma in a Young Patient
DOI:
https://doi.org/10.5195/ijms.2024.2128Keywords:
Intracranial Tuberculoma, pituitary disease, antitubercular agents, Tuberculoma, Sellar Mass, Central Nervous System TB, MRI Imaging, Transsphenoidal Surgery, Pituitary Lesion, Hypopituitarism, Case Report, Anti-Tubercular Therapy, Endocrine DysfunctionAbstract
Background: Tuberculosis of the central nervous system is an uncommon but one of the most severe forms. It manifests as tuberculoma and tuberculous meningitis, with the majority of cases affecting children and immunocompromised patients. Overall, tuberculomas make up to 0.15–2 % of all intracranial lesions but sellar tuberculoma is extremely rare.
The Case: An 18-year-old female patient presented with complaint of generalized weakness, eye pain and headache for 3-4 months. Magnetic resonance imaging (MRI) of brain showed sellar and suprasellar space occupying lesion. Trans sphenoidal approach was used to remove the lesion completely. A sellar tuberculoma was confirmed on pathological evaluation and the patient was put on postoperative anti-tubercular therapy.
Conclusion: Although rare, intracranial tuberculomas, particularly those that originate in the sellar, are notorious for mimicking pituitary tumors by jeopardizing pituitary hormonal function and applying compressive forces on surrounding intracranial structures. However, a prompt assessment can help overcome this diagnostic difficulty with the timely initiation of anti-tubercular therapy (ATT).
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References
Global Tuberculosis Report 2022. Geneva: World Health Organization; 2022.
DeLance AR, Safaee M, Oh MC, Clark AJ, Kaur G, Sun MZ, et al. Tuberculoma of the central nervous system. J Clin Neurosci. 2013;20(10):1333-41.
Ayele B, Wako A, Shewaye A, Tessema A. Sellar Tuberculoma: A rare presentation in a 30-year-old Ethiopian woman: case report. Afr J Neurol Sci. 2019;38(1):50-53.
Dastur HM. Tuberculoma. In: Vinken PJ, Bruyn GW, editors. Handbook of Clinical Neurology, vol. 18. New York: American Elsevier; 1975:413–26.
DeAngelis LM. Intracranial tuberculoma: case report and review of the literature. Neurology. 1981;31(9):1133-6.
Maurice-Williams RS. Tuberculomas of the brain in Britain. Postgrad Med J. 1972;48(565):679-81.
Ranjan A, Chandy MJ. Intrasellar tuberculoma. Br J Neurosurg. 1994;8(2):179-85.
Kumar T, Nigam JS, Jamal I, Jha VC. Primary pituitary tuberculosis. Autops Case Rep. 2020;11: e2020228.
Furtado SV, Venkatesh PK, Ghosal N, Hegde AS. Isolated sellar tuberculoma presenting with panhypopituitarism: clinical, diagnostic considerations and literature review. Neurol Sci. 2011;32(2):301-4.
Pereira J, Vaz R, Carvalho D, Cruz C. Thickening of the pituitary stalk: a finding suggestive of intrasellar tuberculoma? Case report. Neurosurgery. 1995;36(5):1013-5; discussion 1015-6.
Prabha BB, Rangachari V, Subramaniam V, Gopan TV, Baliga VB. Pituitary tuberculoma masquerading as a pituitary adenoma: interesting case report and review of literature. Asian J Neurosurg. 2021;16(1):141-3.
Dutta P, Bhansali A, Singh P, Bhat MH. Suprasellar tubercular abscess presenting as panhypopituitarism: a common lesion in an uncommon site with a brief review of literature. Pituitary 2006;9(1):73-7
Ben Abid F, Abukhattab M, Karim H, Agab M, Al-Bozom I, Ibrahim WH. Primary pituitary tuberculosis revisited. Am J Case Rep. 2017;18:391-4.
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