Tuberculosis of the hypothalamo-pituitary axis is extremely uncommon. The presentation of
panhypopituitarism in a case of sellar
tuberculosis is an even rarer occurrence. We present a case of a 44-year-old man who presented with complaints of
headache and right-sided diminution of vision for six months. A
hormone profile showed abnormal anterior pituitary assay suggestive of
panhypopituitarism. Magnetic Resonance imaging of the brain showed a sellar mass measuring 1.8 × 1.5 × 1.3 cm with suprasellar extension suggestive of a
pituitary adenoma. Histopathological examination showed multiple epithelioid cell
granulomas along with Langhans giant cells and mixed inflammatory infiltrates against a necrotic background. Zeihl Neelson
stain demonstrated the presence of
acid-fast bacilli. Thus, a final diagnosis of pituitary
tuberculoma was made, and the patient started on antitubercular
therapy. It is extremely important to correctly diagnose sellar
tuberculosis as the treatment is entirely different, and the patient usually responds well to
therapy.