Endocrine Abstracts

INTRODUCTION: Intracranial tuberculomas are relatively rare lesions which may become associated with endocrinologic disturbances. We present a case of a 15-year old girl with a series of endocrine disorders commencing at 4 due to the existence of suprasellar tuberculoma lesions.

CLINICAL-LABORATORY EVALUATION: A 3.5 year old girl presented with a positive tuberculin test. Since the rest of the examination and laboratory evaluation were normal, the child received antituberculous chemoprophylaxis. Three months later, she developed a low-grade fever along with drowsiness, headache and symptoms of meningeal irritation. CSF examination revealed 230/mm³ cells with lymphocyte predominance as well as high protein and low glucose levels. On the grounds of tuberculous meningitis (TBM), a 12-month four-drug regimen was administered.Eight months after initiating anti-TBM therapy, the girl developed polyuria and a fluid deprivation test showed inability to concentrate urine normally. Diabetes insipidus was treated with the administration of desmopressin while brain imaging studies displayed tuberculomas in the suprasellar cistern, the right foot of the hippocampus and white matter of the island of Reil. Anti-TBM therapy was extended for one more year and the child placed under close supervision. At the age of 9 she developed secondary hypothyroidism (low TSH, low T4) treated with thyroid hormone and 4 years later cortisol replacement therapy was also initiated due to low cortisol and adrenorticotropin (ACTH) levels. Absence of pubertal signs was also noted and secondary hypogonadism (low FSH, low LH) documented and currently treated with estrogen replacement therapy. Her height was within the normal range and GH-provocative tests revealed normal GH secretion. Serial brain imaging studies revealed the same lesions which had become calcified.

CONCLUSION: The case is illustrated due to the rarity of the multiple endocrine intracranial complications of a common disease which still has many faces.