Stroke-like presentation of a small tuberculum sellae meningioma unmasked by corticosteroid use: A case report

Tuberculum sellae meningiomas are known to cause visual symptoms due to their proximity to the optic apparatus. However, their impact on pituitary function, particularly when the tumor is small, is less frequently described. Although secondary adrenal insufficiency is rare in this context, it may be underrecognized. We report a case in which a small (1.2 cm) tuberculum sellae meningioma resulted in clinically relevant adrenocorticotropin deficiency, unmasked by intra-articular corticosteroid injections. The patient initially presented with nonspecific symptoms and transient ischemic attack-like episodes, which led to imaging and identification of the tumor. Surgical resection of the tumor resulted in complete resolution of symptoms. This case highlights the need for a high index of suspicion for pituitary dysfunction even in small suprasellar tumors and suggests that exogenous corticosteroids may exacerbate underlying hypothalamic-pituitary-adrenal axis compromise.