Autopsy and Case Reports
Autopsy and Case Reports
Clinical Case Report and Review

Primary pituitary tuberculosis

Tarun Kumar; Jitendra Singh Nigam; Iffat Jamal; Vikas Chandra Jha

Downloads: 5
Views: 1352


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.


Tuberculosis, Granuloma, Adenoma, Pituitary Gland


1 World Health Organization. Global Tuberculosis Report 2016. Geneva: WHO; 2016 [cited 2020 June 8]. Available from:

2 Central TB Division. India TB report 2018. New Delhi: Central TB Divison; 2018 [cited 2020 June 8]. Available from:

3 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. PMid:28400550.

4 Srisukh S, Tanpaibule T, Kiertiburanakul S, et al. Pituitary tuberculoma: A consideration in the differential diagnosis in a patient manifesting with pituitary apoplexy-like syndrome. IDCases. 2016;5:63-6. PMid:27516966.

5 Nayil K, Singh S, Makhdoomi R, Ramzan A, Wani A. Sellar-suprasellar tuberculomas in children: 2 cases and literature review. Pediatr Neurol. 2011;44(6):463-6. PMid:21555059.

6 Majumdar K, Barnard M, Ramachandra S, Berovic M, Powell M. Tuberculosis in the pituitary fossa: a common pathology in an uncommon site. Endocrinol Diabetes Metab Case Rep. 2014;2014:140091. PMid:25535577.

7 Bonifacio-Delgadillo D, Aburto-Murrieta Y, Salinas-Lara C, Sotelo J, Montes-Mojarro I, Garcia-Marquez A. Clinical presentation and magnetic resonance findings in sellar tuberculomas. Case Rep Med. 2014;2014:961913. PMid:25114688.

8 Letchworth TW. Tuberculoma of the pituitary body. BMJ. 1924;1(3313):1127. PMid:20771645.

9 Garland HG, Armitage G. Intracranial tuberculoma. J Pathol Bacteriol. 1933;37(3):461-71.

10 Coleman CC, Mederith JM. Diffuse tuberculosis of the pituitary gland simulating tumor, with postoperative recovery. Arch Neurol Psychiatry. 1940;44(5):1076-85.

11 Kirshbaum JD, Levy HA. Tuberculoma of hypophysis with insufficiency of anterior lobe. A clinical and pathologic study of 2 cases. Arch Intern Med (Chic). 1941;68(6):1095-104.

12 Glass SJ, Davis S. Granuloma of the pituitary associated with pan-hypopituitarism. J Clin Endocrinol. 1944;4(10):489-92.

13 Oliver LC. A pituitary tuberculoma. Lancet. 1952;1(6710):698-9. PMid:14909529.

14 Brooks MH, Dumlao JS, Bronsky D, Waldstein SS. Hypophysial tuberculoma with hypopituitarism. Am J Med. 1973;54(6):777-81. PMid:4705420.

15 del Pozo JM, Roda JE, Montoya JG, Iglesias JR, Hurtado A. Intrasellar granuloma. Case report. J Neurosurg. 1980;53(5):717-9. PMid:7431084.

16 Eckland DJ, O’Neill JH, Lightman SL. A pituitary tuberculoma. J Neurol Neurosurg Psychiatry. 1987;50(3):360-1. PMid:3559619.

17 Esposito V, Fraioli B, Ferrante L, Palma L. Intrasellar tuberculoma: case report. Neurosurgery. 1987;21(5):721-3. PMid:3696408.

18 Delsedime M, Aguggia M, Cantello R, et al. Isolated hypophyseal tuberculoma: case report. Clin Neuropathol. 1988;7(6):311-3. PMid:3224474.

19 Ghosh S, Chandy MJ. Intrasellar tuberculoma. Clin Neurol Neurosurg. 1992;94(3):251-2. PMid:1327617.

20 Taparia SC, Tyagi G, Singh AK, Gondal R, Prakash B. Sellar tuberculoma. J Neurol Neurosurg Psychiatry. 1992;55(7):629. PMid:1640248.

21 Higuchi M, Arita N, Mori S, Satoh B, Mori H, Hayakawa T. Pituitary granuloma and chronic inflammation of hypophysis: clinical and immunohistochemical studies. Acta Neurochir (Wien). 1993;121(3-4):152-8. PMid:8512013.

22 Ranjan A, Chandy MJ. Intrasellar tuberculoma. Br J Neurosurg. 1994;8(2):179-85. PMid:7917089.

23 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. PMid:7791965.

24 Ashkan K, Papadopoulos MC, Casey AT, et al. Sellar tuberculoma: report of two cases. Acta Neurochir (Wien). 1997;139(6):523-5. PMid:9248585.

25 Petrossians P, Delvenne P, Flandroy P, Jopart P, Stevenaert A, Beckers A. An unusual pituitary pathology. J Clin Endocrinol Metab. 1998;83(10):3454-8. PMid:9768645.

26 Gazioğlu N, Ak H, Oz B, Seçkin MS, Kuday C, Sarioglu AC. Silent pituitary tuberculoma associated with pituitary adenoma. Acta Neurochir (Wien). 1999;141(7):785-6. PMid:10481794.

27 Sharma MC, Arora R, Mahapatra AK, Sarat-Chandra P, Gaikwad SB, Sarkar C. Intrasellar tuberculoma--an enigmatic pituitary infection: a series of 18 cases. Clin Neurol Neurosurg. 2000;102(2):72-7. PMid:10817892.

28 Sinha S, Singh AK, Tatke M, Singh D. Hypophyseal tuberculoma: direct radiosurgery is contraindicated for a lesion with a thickened pituitary stalk: case report. Neurosurgery. 2000;46(3):735-8, discussion 738-9. PMid:10719871.

29 Basaria S, Ayala AR, Guerin C, Dobs AS. A rare pituitary lesion. J Endocrinol Invest. 2000;23(3):189-92. PMid:10803478.

30 Arunkumar MJ, Rajshekhar V. Intrasellar tuberculoma presenting as pituitary apoplexy. Neurol India. 2001;49(4):407-10. PMid:11799419.

31 Kumar N, Singh S, Kuruvilla A. Pituitary tuberculoma mimicking adenoma: magnetic resonance imaging. Australas Radiol. 2001;45(2):244-6. PMid:11380375.

32 Manghani DK, Gaitonde PS, Dastur DK. Pituitary tuberculoma--a case report. Neurol India. 2001;49(3):299-301. PMid:11593251.

33 Jain R, Kumar R. Suprasellar tuberculoma presenting with diabetes insipidus and hypothyroidism--a case report. Neurol India. 2001;49(3):314-6. PMid:11593255.

34 Domingues FS, de Souza JM, Chagas H, Chimelli L, Vaisman M. Pituitary tuberculoma: an unusual lesion of sellar region. Pituitary. 2002;5(3):149-53. PMid:12812305.

35 Stalldecker G, Diez S, Carabelli A, et al. Pituitary stalk tuberculoma. Pituitary. 2002;5(3):155-62. PMid:12812306.

36 Paramo C, de la Fuente J, Nodar A, Miramontes S, Quintela JL, García-Mayor RV. Intrasellar tuberculoma--a difficult diagnosis. Infection. 2002;30(1):35-7. PMid:11876514.

37 Desai KI, Nadkarni TD, Goel A. Tuberculomas of the hypophysis cerebri: report of five cases. J Clin Neurosci. 2003;10(5):562-6. PMid:12948460.

38 Satyarthee GD, Mahapatra AK. Diabetes insipidus in sellar-suprasellar tuberculoma. J Clin Neurosci. 2003;10(4):497-9. PMid:12852896.

39 Singh S. Pituitary tuberculoma: magnetic resonance imaging. Neurol India. 2003;51(4):548-50. PMid:14742947.

40 Harzallah L, Migaw H, Harzallah F, Kraiem C. Imaging features of intrasellar tuberculoma: two cases. Ann Endocrinol (Paris). 2004;65(3):209-12. PMid:15277978.

41 Trabelsi L, Majdoub-Rekik N, Bouaziz H, et al. Pituitary tuberculosis: a case report. Ann Endocrinol (Paris). 2005;66(4):340-6. PMid:16392184.

42 Deogaonkar M, De R, Sil K, Das S. Pituitary tuberculosis presenting as pituitary apoplexy. Int J Infect Dis. 2006;10(4):338-9. PMid:16413219.

43 Bayindir C, Mete O, Bilgic B. Retrospective study of 23 pathologically proven cases of central nervous system tuberculomas. Clin Neurol Neurosurg. 2006;108(4):353-7. PMid:16644403.

44 Sunil K, Menon R, Goel N, et al. Pituitary tuberculosis. J Assoc Physicians India. 2007;55:453-6. PMid:17879504.

45 Yilmazlar S, Bekar A, Taskapilioglu O, Tolunay S. Isolated intrasellar tuberculoma mimicking pituitary adenoma. J Clin Neurosci. 2007;14(5):477-81. PMid:17346976.

46 Saini KS, Patel AL, Shaikh WA, Magar LN, Pungaonkar SA. Magnetic resonance spectroscopy in pituitary tuberculoma. Singapore Med J. 2007;48(8):783-6. PMid:17657390.

47 Rao S, Rajkumar A, Kuruvilla S. Sellar lesion: not always a pituitary adenoma. Indian J Pathol Microbiol. 2008;51(2):269-70. PMid:18603706.

48 Husain N, Husain M, Rao P. Pituitary tuberculosis mimicking idiopathic granulomatous hypophysitis. Pituitary. 2008;11(3):313-5. PMid:17786560.

49 Behari S, Shinghal U, Jain M, et al. Clinicoradiological presentation, management options and a review of sellar and suprasellar tuberculomas. J Clin Neurosci. 2009;16(12):1560-6. PMid:19783148.

50 Salem R, Khochtali I, Jellali MA, et al. Isolated hypophyseal tuberculoma: often mistaken. Neurochirurgie. 2009;55(6):603-6. PMid:19615704.

51 Mittal P, Dua S, Saggar K, Gupta K. Magnetic resonance findings in sellar and suprasellar tuberculoma with hemorrhage. Surg Neurol Int. 2010;1:73. PMid:21170364.

52 Domiciano DS, de Carvalho JF, Macedo AR, Laurindo IM. Central diabetes insipidus induced by tuberculosis in a rheumatoid arthritis patient. Acta Reumatol Port. 2010;35(2):232-5. PMid:20711095.

53 Shukla S, Trivedi A, Singh K, Sharma V. Pituitary tuberculoma. J Neurosci Rural Pract. 2010;1(1):30-1. PMid:21799616.

54 Ranjan R, Agarwal P, Ranjan S. Primary pituitary tubercular abscess mimicking as pituitary adenoma. Indian J Endocrinol Metab. 2011;15(Suppl 3):S263-66. PMID: 22029038.

55 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. PMid:20886253.

56 Saito K, Toda M, Shido S, Tomita T, Ogawa K, Yoshida K. Isolated pituitary tuberculoma. NMC Case Rep J. 2014;1(1):33-6. PMid:28663950.

57 Jain A, Dhanwal DK, Kumar J. A rare case of pituitary tuberculoma-diagnosed and managed conservatively. Pituitary. 2015;18(4):579-80. PMid:24893866.

58 Tanimoto K, Imbe A, Shishikura K, et al. Reversible hypopituitarism with pituitary tuberculoma. Intern Med. 2015;54(10):1247-51. PMid:25986265.

59 Ates I, Katipoglu B, Copur B, Yilmaz N. A rare cause of hypophysitis: tuberculosis. Endocr Regul. 2017;51(4):213-5. PMid:29232189.

60 Pamidimukkala V, Sahebrao Mandwe D, K SR, Batsala H. K SR, Batsala H. Primary pituitary tubercular abscess as a differential diagnosis for sellar suprasellar mass. Br J Neurosurg. 2019;33(4):437-8. PMid:28741962.

61 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.

62 Chen M, Song C, Liu H. A rarely encountered case: a patient with primary pituitary tuberculosis and stroke. Neurosci Bull. 2018;34(3):546-8. PMid:29663174.

63 Zia-Ul-Hussnain HM, Farrell M, Looby S, et al. Pituitary tuberculoma: a rare cause of sellar mass. Ir J Med Sci. 2018;187(2):461-4. PMid:28733940.

64 Roka YB, Roka N, Pandey SR. Primary pituitary tubercular abscess: a case report. JNMA J Nepal Med Assoc. 2019;57(217):206-8. PMid:31477965.

65 Agrawal VM, Giri PJ. Tuberculosis: a common infection with rare presentation, isolated sellar tuberculoma with panhypopituitarism. J Neurosci Rural Pract. 2019;10(2):327-30. PMid:31001028.

Submitted date:

Accepted date:

Publication date:

5fcfc13b0e8825c0014ac22d autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections