Primary pituitary tuberculoma with a pituitary apoplexy-like presentation.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Gaayathri Krishnan, Nur Hidayah Mohd Makhatar, Tee Hwee Ching, Serena Khoo
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引用次数: 0

Abstract

Summary: 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.

Learning points: 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.

原发性垂体结核瘤伴有垂体中枢神经瘫痪样表现。
摘要:垂体结核瘤极为罕见,尤其是在没有其他全身结核病表现的情况下作为孤立病变出现时,可能会给诊断带来困难。一名 21 岁女性因糖尿病酮症酸中毒入院。入院第三天,糖尿病酮症酸中毒缓解后,她突然出现头痛和视力模糊,提示垂体性脑瘫。紧急进行的脑部磁共振成像检查发现了一个巨大的蝶窦肿块,肿块侵蚀到了蝶窦,并伴有颅内血管炎。经蝶窦手术进行了肿瘤剥离,对蝶窦肿块进行了组织病理学检查。蝶窦肿块的免疫组化检查显示基因 Xpert MTB/Rif 阳性,提示为结核瘤。患者开始接受抗结核治疗,治疗后 7 个月垂体激素水平完全恢复。在结核病高发地区,在对蝶窦病变进行诊断评估时应考虑结核瘤:学习要点:在结核病流行的地区,在评估蝶窦病变时应将结核瘤作为鉴别诊断。垂体结核瘤可表现为垂体下垂样症状。及时诊断和治疗可恢复垂体功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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