Pituitary
tuberculoma is extremely rare, even in endemic regions of
tuberculosis and much less frequently as a presentation of
pituitary apoplexy. We describe a 25-year-old female presented with sudden onset of
headache and vision loss of left eye which mimicking symptoms of
pituitary apoplexy. MRI of the pituitary gland showed a rim-enhancing lesion at the intrasellar region extending into the suprasellar area, but absence of posterior bright spot with enhancement of the pituitary stalk. Pituitary hormonal evaluation revealed
panhypopituitarism and
diabetes insipidus. An urgent transphenoidal surgery of the pituitary gland was undertaken for which the histopathology showed necrotizing granulomatous
inflammation with infarcted adjacent pituitary tissue. Despite negative fungal and AFB staining, pituitary
tuberculoma was presumptively diagnosed based on imaging, pathology and the high incidence of
tuberculosis in the country. After the course of anti-
tuberculosis therapy, the clinical findings were dramatically improved, supporting the diagnosis. Pituitary
tuberculoma is extremely rare in particular with an
apoplexy-like presentation but should be one of the differential diagnosis list of intrasellar lesions in the patient presenting with sudden onset of
headache and visual loss. The presence of
diabetes insipidus and thickened with enhancement of pituitary stalk on MRI were very helpful in diagnosing pituitary
tuberculosis.