ESPE Abstracts

Background and methods: Sellar and suprasellar tuberculomas are extremely rare in children and most often patients present with headache, vomiting, visual disturbances, and hypofunction of the pituitary gland. Here, we report a girl with hypothalamic obesity, that recovers after antituberculosis treatment.

Findings: An 11-year old girl presented with headache, fever and anorexia that progressively evolved into an encephalopathic status with cranial nerve paresis: ptosis on the right side and bilateral paresis of the abducens nerve. Brain MRI showed meningeal contrast capture along cranial nerves II (including optic chiasm), III, V and VI bilaterally and multiple contrast enhancing brain parenchyma lesions. Tuberculin skin test was negative but interferon-gamma release assay was positive. The clinical and radiological working diagnosis was consistent with tuberculous meningoencephalitis. Pulse corticosteroids for 3 days and quadruple antituberculosis therapy were started and the girl demonstrated obvious improvement of her neurological symptoms. However, after a few months of therapy she developed remarkable hypothalamic obesity and growth arrest. She gained 20 kg in one year. Her hormone profile revealed insulin resistance (homeostasis model assessment-estimated insulin resistance 6.8) and growth hormone deficiency (circulating insulin-like growth factor-I 104 μg/l (-2.4 SD)). Repeat brain MRI showed a decrease in basal meningitis, but increased parenchymal lesions in the hypothalamic region extending medially into the nucleus lentiformis, with now a voluminous tuberculoma at this site. Antituberculosis treatment was continued for a total of 18 months. The patient improved clinically, she regained her pre-illness BMI and her growth rate increased. On the hormonal side, the disappearance of insulin resistance (HOMA-IR 2.5) and of growth hormone deficiency (circulating IGF-I 175 μg/l (-1.4 SD)) was noted, and her last brain MRI showed a remarkable volume reduction of the suprasellar tuberculoma.

Conclusion: Pituitary tuberculosis can have a very dynamic presentation during the active stage of the disease, which can be reversed by prolonged anti-tuberculosis treatment. Previous studies showed that the tuberculous process can also cause long term and permanent changes in the hypothalamic-pituitary axis. Prospective studies are however needed in the pediatric population to know the exact incidence and type of endocrine dysfunction.