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Tubercular Hypophysitis Mimicking Autoimmune Hypophysitis: A Case Report
摘要
Background: Tuberculosis rarely involves the central nervous system. Even rarer is tuberculous infection of the pituitary gland. Methods: We report a young, immunocompetent woman without known exposure to infection presented with weight loss, menstrual delay, and polyuria. Results: Central diabetes insipidus was confirmed via water deprivation test. Laboratory tests for pituitary function were significant for hyperprolactinemia and hypogonadotropic hypogonadism. Magnetic resonance (MR) imaging revealed a thickened and intensely enhanced pituitary stalk as well as enlargement of the pituitary gland, suggesting inflammation. The patient was treated medically for presumed autoimmune hypophysitis with glucocorticoid as well as cabergoline and desmopressin. Initial positive response to treatment was followed by recrudescence of hyperprolactinemia and progression of pituitary abnormalities on MR images. Subsequently, stereotactic surgical biopsy and pathological examination of the pituitary revealed granulomatous inflammation and the presence of Mycobacterium tuberculosis. After completing anti-tuberculosis treatment, MR imaging showed resolution of the suprasellar mass lesion, but amenorrhea persisted. Conclusion: Tubercular hypophysitis may be indistinguishable from autoimmune hypophysitis on clinical grounds. A lack of expected response to medical therapy should prompt surgical biopsy of the pituitary for definitive diagnosis.