Presentation
Headache and fever
Patient Data
Few small lytic areas in the basisphenoid/dorsum sellae.
The pituitary stalk appears mildly bulky.
The brain is otherwise unremarkable.
Homogeneously enhancing mildly bulky pituitary gland and pituitary stalk with normal size sella. There is the erosion and heterogenous enhancement of the clivus/dorsum sellae/basisphenoid associated with thick dural enhancement along the clivus. Oedema noted in bilateral optic tracts.
Small mucosal polyp in the sphenoid sinus.
Mild hypertrophy of adenoid.
Impression: Overall imaging findings are in favour of granulomatous hypophysitis
Case Discussion
The CSF study was done and the results are as follows-
Total leucocyte count: 220 cells/cumm.
Differential leucocyte count:
Neutrophils 10%
Lymphocytes: 90%
No immature / abnormal cells were seen.
RBC count: few
Glucose: 20 mg/dl (decreased).
Protein: 279 mg/dl (increased).
Chloride: 115 mmol/L (dereduced
---- The overall clinical history, imaging findings, and CSF study are in favour of Tubercular granulomatous hypophysitis.
Co-authors:
Dr. Mukund prasad, Mch (Neurosurgery).
Dr. Saket ballabh, DMRD, DNB (Radiodiagnosis).
Dr. Sanaullah mudassir, DM (Neuro medicine)
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