Case Report

Clinical Presentation and Magnetic Resonance Findings in Sellar Tuberculomas

Table 1

Series previously reported.

Author, year (reference number)Patient Sex/AgeClinical presentation

Garlan and Armitage, 1933 [4]2 patientsAge and gender not mentioned in the paper
Coleman and Meredith, 1940 [5]1 patientPrimary optic atrophy and bitemporal hemianopia
Glass and Davis, 1944 [46]M/54 YPanhypopituitarism with febrile episodes
Brooks et al., 1973 [6]F/33 YHeadache, diminution of vision, and past history of pulmonary Koch
Eckland et al., 1987 [7]F/37 YBitemporal headache, vomiting, and diplopia. Right sixth nerve palsy, right temporal hemianopia and a depressed right corneal reflex lateral gaze to the right
Esposito et al., 1987 [8]F/54 YHeadache with loss visual acuity in the left eye and diplopia on left lateral gaze. History pulmonary tuberculosis at the age of 22
Delsedime et al., 1988 [9]F/45 YIsolated tuberculous granuloma of the hypophysis with no other systemic localizations
Kamiya et al., 1991 [10]M/41Headache, history of pulmonary tuberculosis at the age of 20
Taparia et al., 1992 [34]M/40 YIntermittent dull headache. Visual acuity reduced and bilateral optic atrophy
Ghosh and Chandy, 1992 [11]F/35 YHeadache, vomiting, blurred vision, amenorrhea, and galactorrhea
Ranjan and Chandy, 1994 [36]Five patientsIn four cases the clinical and radiological diagnosis was that of a pituitary adenoma. One patient presented similar to a subarachnoid haemorrhage, but the CSF analysis was suggestive of tuberculous meningitis. All these patients presented either with intermittent headache. Hypopituitarism was diagnosed in two patients and one patient had an associated galactorrhoea-amenorrhoea syndrome. Only one patient had a bitemporal field cut. In all other patients ophthalmological examination was normal
Pereira et al., 1995 [12]F/55 YLeft sixth nerve palsy and headaches
Ashkan et al., 1997 [13]F/33 Y
F/31 Y
Secondary amenorrhea, fatigue, headache and weight loss
Secondary amenorrhea, galactorrhea and headache
Petrossians et al., 1998 [35]F/54 YExtreme weakness, headache, and vomiting
Gazioğlu et al., 1999 [14]F/34 YAcromegaly, oligomenorrhea, and hypertrichosis
Sharma et al., 2000 [15]18 cases
Range:
8–43 Y
The duration of symptoms varied from 15 days to 2 years (average 4 months); the most common symptoms being headache followed by decrease or loss of vision. Five patients had features of panhypopituitarism whereas three had raised prolactin (PRL) levels. In three patients, there was past history of pulmonary tuberculosis
Basaria et al., 2000 [16]FPituitary mass, presumed preoperatively to be an adenoma. The patient did not have history of tuberculosis infection
Arunkumar and Rajshekhar, 2001 [3]M/27 Y3 previous episodes of pituitary apoplexy
Kumar et al., 2001 [17]1 patientPituitary mass with clinical and MRI findings consistent with adenoma
Manghani et al., 2001 [37]F/24 YHeadache and loss of libido
Domingues et al., 2002 [18]F/46 YConfusion and hypopituitarism with no evidence of systemic tuberculosis
Stalldecker et al., 2002 [19]F/16 YHeadache, hyperpyrexia, polyuria, polydipsia and amenorrhea
Desai et al., 2003 [20]F/15 Y
F/19 Y
F/22 Y
F/30 Y
M/47 Y
Headache, amenorrhoea, galactorrhoea, diminution of vision, bitemporal hemianopia, past history of pulmonary Koch
Headache, amenorrhoea
Headache, amenorrhoea, diminution of vision, bitemporal hemianopia, past history of Koch’s cervical adenopathy
Headache, oligomenorrhoea, galactorrhoea
Headache
Satyarthee and Mahapatra, 2003 [21]F/32 YDiabetes insipidus and secondary amenorrhea
Harzallah et al., 2004 [22]F/52 Y
M/62 Y
Extreme weakness, headache, vomiting, meningeal syndrome and third cranial nerve palsy
Generalized tonic-clonic seizure, low grade fever and mental confusion
Trabelsi et al., 2005 [23]F/42 YHistory of erythema nodosum, poliuria, polydipsia, amenorrhea and galactorrhea
Deogaonkar et al., 2006 [24]F/27Headaches, left ptosis and left facial numbness. Drowsy and obtunded, tachycardia with blood pressure normal. Left facial hypoesthesia in left V1 and V2 distribution. Her hormone profile did not reveal any abnormality
Bayindir et al., 2006 [25]1 patientAge and gender no mentioned in the article
Sunil et al., 2007 [2]M/42 YPolyuria, polydypsia, polyphagia, and decreased libido secondary to diabetes mellitus
Yilmazlar et al., 2007 [26]F/37 YGalactorrhea and menstrual irregularity
Husain et al., 2008 [27]F/40 YHeadache and fatigue
Rao et al., 2008 [28]F/47 YDiabetic, hypothyroid and hypertensive. Presented with headache, vomiting, transient blurring of vision and galactorrhea.
Behari et al., 2009 [29]8 cases, Range: 15–40 Y M : F ratio = 5 : 3Range of duration of clinical symptomatology, 6 months–3 years
Headache was again the predominant symptom in most patients, which resulted from raised intracranial pressure due to both the large size of the lesion as well as the coexisting hydrocephalus. One patient presented with headache due to pachymeningitis, one due to stretching of the diaphragma sellae by an intrasellar tuberculous abscess, and the third due to clival infiltration. Three of our patients had either a previous history of tuberculosis or a concomitant lesion at some other site
Mittal et al., 2010 [30]F/40 YPersistent headache and blurred vision on the left side
Domiciano et al., 2010 [31]F/33 YNodular RA who was being treated with methotrexate, sulfasalazine and corticosteroids and presented with subcutaneous nodules simultaneously with aseptic meningitis. Mycobacterium tuberculosis was identified in cultures from a biopsy of an axillary nodule. The patient also developed polyuria and polydipsia with normal glycemia
Shukla et al., 2010 [32]M/68 YHolocranial headache of four months duration with left temporal hemianopia, with visual acuity of 6/6, without any localizing sign
Furtado et al., 2011 [33]F/31 YPanhypopituitarism