Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Sign up to receive an email alert when a new Case of the Week is posted.
December 3, 2020
Pituitary Stalk Tuberculoma
- Background:
- Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. The lungs are the most common site of involvement. Extrapulmonary sites of infection, involved in ~20% of immunocompetent patients, can occur in any organ with or without overt pulmonary involvement.
- Pituitary tuberculoma as an isolated manifestation of the disease is very rare.
- Tuberculosis can affect the pituitary stalk via formation of a tuberculoma, granulomatous involvement, or postinfectious fibrosis.
- Women are more frequently affected.
- Clinical Presentation:
- Headache, visual disturbances, abnormal pituitary function, pituitary apoplexy, diabetes insipidus
- Key Diagnostic Features:
-
Tuberculomas are isointense to hypointense on T1-weighted images and may show variable signal on T2-weighted images with thickening of the pituitary stalk and postcontrast enhancement.
-
Adjacent meningeal enhancement may be present.
-
Pituitary abscesses show peripheral contrast enhancement.
-
- Differential Diagnoses:
- Pituitary stalk tuberculoma is a rare condition and requires histologic correlation for definitive diagnosis.
- Lymphocytic hypophysitis: Pituitary stalk thickening, loss of the tapering at pituitary insertion, marked postcontrast enhancement, and absence of normal enhancement of the neurohypophysis are seen.
- Neurosarcoidosis: Pituitary stalk thickening and enhancement, pituitary enlargement, periventricular lesions, and leptomeningeal enhancement can be seen.
- Wegener granulomatosis: Enlarged pituitary with homogeneous enhancement, thickening and enhancement of the pituitary stalk, and enhancement of the optic chiasm are present.
- Langerhans cell histiocytosis: Asymmetrically thickened pituitary stalk/hypothalamic mass, isointense on T1WI, hyperintense on T2WI, postcontrast enhancement with loss of posterior pituitary enhancement
- Metastasis: Presents as pituitary stalk thickening with a known primary tumor, most common primary sites being breast and lung carcinoma
- Lymphoma: May present intracranially as isolated stalk thickening or in conjunction with periventricular enhancing masses
- Treatment:
- Antitubercular therapy
Current Issue
Case Collections
