ESPE Abstracts (2022) 95 P1-557

ESPE2022 Poster Category 1 Pituitary, Neuroendocrinology and Puberty (77 abstracts)

Pituitary tuberculosis and hypothalamic obesity can be reversed by prolonged anti-tuberculosis treatment

Anne Rochtus 1,2 , Lieven Lagae 2 , Francois Vermeulen 3 & Francis de Zegher 1

1Department of Pediatric Endocrinology, University Hospitals Leuven, Leuven, Belgium; 2Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium; 3Department of Pediatric Infectiology, University Hospitals Leuven, Leuven, Belgium

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.

Volume 95

60th Annual ESPE (ESPE 2022)

Rome, Italy
15 Sep 2022 - 17 Sep 2022

European Society for Paediatric Endocrinology 

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