Endocrine Abstracts

Tuberculosis affecting the pituitary gland is a rare phenomenon and is usually the result of haematological spread from another site. Only 0.9% of cases of TB in the UK, in 2012, showed any CNS involvement, excluding meningitis¹. The clinical presentation of pituitary TB, range of hormonal dysfunction and radiological features can vary, making it hard to identify the condition. We report two clinical cases seen in our department.

Case 1: A 48-year-old female from Somalian, was referred with a 7-month history of lethargy and blood tests suggesting secondary hypothyroidism. Subsequent endocrine investigations confirmed panhypopituitarism and diabetes insipidus. An MRI pituitary showed the pituitary gland to be bulky with loss of the posterior pituitary bright spot and increased signal in the lower end of the stalk. CT chest showed no mediastinal or hilar lymphadenopathy, however, 2.5 cm right axillary lymphadenopathy was seen. An ultrasound guided FNA was performed; TB culture isolated acid fast bacilli and PCR confirmed the presence of Mycobacterium tuberculosis complex.

Case 2: A 40-year-old female from Cameroon, was referred whilst receiving inpatient treatment for multi-drug-resistant TB with blood tests suggestive of secondary hypothyroidism. Imaging performed for a new right CN VI palsy showed a bulky pituitary gland when reviewed retrospectively. The remainder of her pituitary profile was normal. Her thyroid function tests normalised with ongoing TB treatment, as did her radiological features.

The incidence of tuberculosis in London, in 2012, was much higher than any other capital in Western Europe (41.8 cases/100 000 population)¹. Previous case reports have shown a delay in identifying pituitary TB can lead to unnecessary surgical intervention and more permanent endocrinopathies. We must exercise vigilance and consider the diagnosis early, especially in high risk groups.

References: 1. Tuberculosis in the UK: 2013 Report – Public Health England.