title: Primary Pituitary Tuberculosis Revisited.
abstract: BACKGROUND Primary pituitary tuberculosis (in absence of other organ involvement and constitutional symptoms) is an extremely rare disease with total reported cases in the literature fewer than a hundred. Misdiagnosis as pituitary adenoma is common and late diagnosis can result in a permanent endocrine dysfunction and/or long-term neurologic sequelae. CASE REPORT We report on the case of a middle-aged woman who presented with severe headache and left third cranial nerve palsy. Magnetic resonance imaging (MRI) revealed a large pituitary tumor invading the left cavernous sinus. The case was initially misdiagnosed as pituitary adenoma. A pituitary biopsy was performed and was suggestive of pituitary tuberculosis. Extensive radiologic investigations did not reveal any evidence of other organ involvement by tuberculosis. She was successfully treated with anti-tuberculous medications. CONCLUSIONS In areas with a high pre-test probability of tuberculosis, pituitary tuberculosis should be included in the differential diagnosis of pituitary tumors in order to avoid unnecessary surgical interventions. Besides being the first histologically-proven primary pituitary tuberculosis case reported from Qatar, the current case is unique in that extensive radiologic investigations did not reveal any evidence of other systemic or pulmonary tuberculosis.
authors.affiliation: Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Fatma
authors.initials: F
authors.lastname: Ben Abid
authors.affiliation: Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abukhattab
authors.affiliation: Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Hanfa
authors.initials: H
authors.lastname: Karim
authors.affiliation: Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Agab
authors.affiliation: Department of Pathology, Hamad General Hospital, Doha, Qatar.
authors.forename: Issam
authors.initials: I
authors.lastname: Al-Bozom
authors.affiliation: Department of Medicine, Hamad General Hospital, Doha, Qatar.
authors.forename: Wanis H
authors.initials: WH
authors.lastname: Ibrahim
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000209:etiology; D010900:Pituitary Diseases / Q000175:diagnosis / Q000382:microbiology*; D010911:Pituitary Neoplasms / Q000175:diagnosis; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis*