Clinical Features, Diagnosis and Treatment of Primary Pituitary Tuberculosis: A Systematic Review of the Literature
Luis Diaz Tejada1, Luciana Aguirre1, Wagner Rios-Garcia2, Jhon Bocanegra-Becerra1
1School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru, 2Universidad Nacional San Luis Gonzaga, Ica, Peru
Objective:
To synthesize the available evidence on the diagnosis and treatment of primary pituitary tuberculosis (PPT).
Background:
PTT is a rare extrapulmonary manifestation of tuberculosis that may mimic neoplastic or inflammatory lesions of the pituitary gland, potentially leading to diagnostic and therapeutic delays. Moreover, it can be associated with significant morbidity due to involvement of the visual and endocrine systems. A systematic literature review is warranted to better characterize its clinical features, diagnostic challenges, and treatment outcomes.
Design/Methods:
Following PRISMA guidelines, PubMed, EMBASE, SCOPUS, and LILACS databases were searched up to September 2024. Original reports describing the diagnosis and treatment of PPT were included. Information was summarized in counts and proportions.
Results:
Fifty studies comprising 74 patients (mean age: 34.47 years; 68% female) were analyzed. The pituitary gland was affected in 97% of cases and the pituitary stalk in 3%. The most frequent symptoms were headaches (55%) and visual impairment (47%). Magnetic resonance imaging (MRI) data were available for 48 patients and revealed suprasellar extension (73%), optic chiasm compression (46%), and pituitary stalk thickening (41%).
All patients received anti-tuberculosis therapy, mostly under an extended drug regimen. Surgery was performed in 69% of cases, predominantly via a transsphenoidal approach (64%). Following treatment, 55% of patients experienced visual improvement, and 89% achieved complete or near-complete clinical resolution. Postoperative diabetes insipidus occurred in 11% of cases. Other endocrine disturbances included hypocortisolism (14%), central hypothyroidism (12%), hyperprolactinemia (12%), and panhypopituitarism (11%). Approximately 19% of patients required long-term hormone replacement therapy. No mortality was reported among the 63 patients with available follow-up data.
Conclusions:
PPT is an important entity to consider in the differential diagnosis of sellar lesions, particularly in endemic regions. Prompt diagnosis, combined with anti-tuberculosis therapy, surgery, and appropriate hormone replacement, remains pivotal and can mitigate morbidity.
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