Endocrine Abstracts

Hypophysitis is a heterogeneous inflammatory disease of pituitary gland. As it causes headache and visual defects, it mimics sellar tumors in clinical and radiological aspects. It may occur due to primary or secondary causes. Tuberculosis is one of the rare secondary causes of hypophysitis. A young male patient presented with fatigue and headache and diagnosed with tubercular hypophysitis as a result of performed tests is discussed hereby in the case report. A 30 year old male patient presented to out clinic with fatigue, malaise, somnolence and headache. It was learned that the onset of the complaints was three months before and they gradually increased since then. There was no chronic disease, medication, herbal agent or alcohol use in the patient anamnesis. Overall medical condition of the patient was moderate with 36.7 °C body temperature, 80/50 mmHg arterial blood pressure and 50/min heart rate. Physical examination revealed no abnormal finding other than icteric sclera. Due to the pathologic findings of 0.05 ng/dl free thyroxine level, 2.04 pg/ml free triiodothyronine level and 0.46 u/ml of thyroid-stimulating hormone, further tests were performed on the patient for a pre-diagnosis of central hypothyroidism. Tests performed for etiology resulted in 0.82 ug/dl cortisol, 0,1 mlu/ml luteinizing hormone, 7.97pg/ml adrenocorticotropic hormone and 2.68 mlu/ml follicle stimulating hormone. Panhypopituitarism was considered due to these results. Levothyroxine and prednisolone treatment was initiated. Diagnostic magnetic resonance (MR) imaging was performed. Imaging revealed height of pituitary gland 14 mm higher than normal. No heterogeneity was observed at pituitary gland level. Biopsy of pituitary gland was performed for establishing diagnosis and result was concordant with granulomatous hypophysitis. TORCH panel, herpes simplex virus, Brucella, Epstein–Barr, parvovirus, varicella-zoster, T. pallidum tests were negative. Adenosine deaminase (ADA) level was 45, in the upper limit. Tuberculin skin test (PPD) resulted in 22 mm induration and QuantiFERON-TB gold test was positive. Hypophysitis developed secondary to tuberculosis was considered. In addition to the current treatment, anti-tuberculosis (isoniazid, streptomycin, pyrazinamide, rifampin) treatment was initiated. The dose of administered prednisolone was gradually (24 -> 18 -> 12 -> 8 -> 75 -> 5 -> 4 mg / day) increased along the course of treatment. The need for steroid was completely eliminated by month 6 of tuberculosis treatment. In cases such as tubercular hypophysitis developing due to secondary causes, early diagnosis is very important given that panhypopituitarism may be completely eliminated in clinical terms following an effective anti-tuberculosis treatment. Therefore, tubercular hypophysitis should be kept considered for cases referred with hypopituitarism clinic and suggesting secondary hypophysitis.