Endocrine Abstracts

A 28-year-old man of Asian origin presented with fever, cough and weight loss over 4 weeks. He had symptoms of worsening headaches and vomiting. The chest X-ray was normal and due to persistent headache and vomiting a lumbar puncture was performed following a normal CT head scan. The CSF findings confirmed the diagnosis of tubercular meningitis and the patient received a complete course of anti tubercular treatment. Six months later he was readmitted with visual blurring, a diagnosis of optic neuritis was made and he was treated with steroids. The patient re-presented in a few months with symptoms of polyuria, polydipsia and excessive tiredness. The biochemistry demonstrated evidence of secondary hypothyroidism and subsequent testing confirmed anterior hypopituitarism. The patient was commenced and hydrocortisone, thyroxine and testosterone. Symptoms of diabetes insipidus resolved following hormone replacement and a water deprivation test undertaken at a later date was completely normal.

Pituitary tuberculosis is extremely rare and a reported incidence of 4% in patients with tuberculosis has been quoted in the literature. It accounts for ~0.15% of all intracranial tumours and 0.6% of all intracranial TB. Endocrine dysfunction has been reported to occur in patients with tubercular meningitis and the most commonly reported endocrinopathies include adrenal insufficiency, central hypothyroidism and hyperprolactinemia. Hypopituitarism has been reported to occur years after recovery from the illness in some patients who had suffered from tubercular meningitis in their childhood. Trans-sphenoidal biopsy has been considered to be essential to establish the diagnosis. Anti tubercular treatment regimes used in CNS tuberculosis have been used to effectively treat pituitary tuberculosis. It is important for the endocrine fraternity to recognise pituitary tuberculosis and tubercular meningitis as rare causes of hypothalamic pituitary insufficiency as anti tubercular treatments are curative.