Pituitary Tuberculosis
Pituitary Tuberculosis in Children
Key Points
- Rare manifestation of extrapulmonary tuberculosis
- Usually occurs through hematogenous spread
- Can present as a sellar mass mimicking pituitary adenoma
- More common in endemic TB regions
- Often associated with systemic tuberculosis
Pathophysiology
Pituitary tuberculosis typically develops through:
- Direct hematogenous spread from primary infection
- Extension from adjacent infected bone or meninges
- Formation of tuberculomas within the pituitary gland
- Granulomatous inflammation causing destruction of pituitary tissue
Risk Factors
- Immunocompromised status
- Living in TB endemic areas
- Previous history of tuberculosis
- Malnutrition
- Close contact with TB patients
Clinical Presentation
Common Symptoms
- Headache (most common presenting symptom)
- Visual disturbances
- Growth failure
- Delayed puberty
- Polyuria and polydipsia (diabetes insipidus)
Endocrine Manifestations
- Hypopituitarism
- Growth hormone deficiency
- Secondary hypothyroidism
- Secondary adrenal insufficiency
- Hypogonadotropic hypogonadism
- Hyperprolactinemia
- Central diabetes insipidus
Neurological Signs
- Visual field defects
- Cranial nerve palsies
- Meningeal signs
- Raised intracranial pressure symptoms
Diagnostic Approach
Laboratory Investigations
- Pituitary hormone profile:
- Growth hormone
- IGF-1
- Thyroid function tests
- Cortisol levels
- Prolactin
- Gonadotropins
- ESR and CRP
- Tuberculin skin test
- Interferon-gamma release assays
Imaging Studies
- MRI findings:
- Sellar mass with rim enhancement
- Thickened pituitary stalk
- Inflammatory changes
- Central caseation or necrosis
- CT scan features
- Chest X-ray for primary focus
Definitive Diagnosis
- Histopathological examination showing:
- Granulomatous inflammation
- Caseous necrosis
- Epithelioid cells
- Langhans giant cells
- PCR for Mycobacterium tuberculosis
- Culture studies
Treatment Protocol
Anti-tubercular Therapy
- Intensive phase (2 months):
- Isoniazid
- Rifampicin
- Pyrazinamide
- Ethambutol
- Continuation phase (7-10 months):
- Isoniazid
- Rifampicin
Hormone Replacement
- Glucocorticoid replacement
- Thyroid hormone replacement
- Growth hormone therapy
- Sex hormone replacement
- Desmopressin for diabetes insipidus
Surgical Intervention
- Indications:
- Large tuberculomas
- Significant mass effect
- Progressive visual deterioration
- Diagnostic uncertainty
- Surgical approaches:
- Transsphenoidal surgery
- Transcranial approach
Complications and Follow-up
Potential Complications
- Permanent hypopituitarism
- Visual impairment
- Growth failure
- Cognitive impairment
- Meningitis
- Cavernous sinus syndrome
Monitoring
- Regular hormone assessments
- Growth monitoring
- Visual field testing
- MRI follow-up
- Treatment response evaluation
Long-term Outcomes
- Recovery potential with early diagnosis
- Need for lifelong hormone replacement in some cases
- Regular endocrine follow-up
- Quality of life considerations
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
