Abstract
Primary pituitary tubercular abscess is a very rare disease. It may present clinically with visual loss, headache, seizure, hormonal abnormalities or with cranial nerve palsies. MRI is the diagnostic modality and shows a cystic-solid mass in the sellar and suprasellar region, isointense on T1 and T2W images with heterogeneous areas and ring enhancement on contrast. Surgery remains the initial treatment and it is approached through the trans-sphenoidal/trans-nasal or transcranial route followed by anti-tubercular therapy. We report a case of primary pituitary tubercular abscess managed successfully with a brief review of its pathology. Keywords: abscess; pituitary gland; pyogenic; sella; tuberculosis.
Highlights
Primary pituitary tubercular abscess (PTA) is a very rare disease.[1,2,3,4] Tuberculoma of the sellar region and intracerebral tubercular abscess are more common than tubercular pituitary abscess
Unlike pyogenic abscess which can spread by both hematogenous or local spread, PTA is entirely secondary to hematogenous spread
Primary PTA is a rare disease which was first described in 1940.6 Tubercular abscess of the brain and tuberculomas of the sellar region are more commonly found than PTA.[7,8]
Summary
Primary pituitary tubercular abscess (PTA) is a very rare disease.[1,2,3,4] Tuberculoma of the sellar region and intracerebral tubercular abscess are more common than tubercular pituitary abscess. It may present clinically with visual loss, headache, seizure, hormonal abnormalities or with cranial nerve palsies.[5] Radiologically, it can mimic a pituitary adenoma, arachnoid cyst, colloid cyst, pyogenic abscess, metastasis or craniopharyngioma. The majority are managed with an initial diagnosis of adenoma with postoperative histopathology showing PTA.
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