A case of central nervous system tuberculosis with pituitary involvement and diabetes insipidus: A literature review

doi:10.19983/j.issn.2096-8493.20250095

Abstract

Abstract:

Objective: To investigate the clinical characteristics of central nervous system tuberculosis (CNS-TB) complicated by diabetes insipidus (DI), with the aim of providing insights to inform and improve clinical diagnosis and management. Methods: We present a case of central nervous system tuberculosis (CNS-TB) in which DI was the initial manifestation, describing the clinical presentation, laboratory findings, imaging characteristics, treatment course, and clinical outcome. In addition, a comprehensive literature review was conducted by searching PubMed, Wanfang, VIP, and the China National Knowledge Infrastructure (CNKI) databases using the keywords “tuberculosis” “tuberculous meningitis” and “diabetes insipidus”. The search covered publications from January 2000 to June 2025. Case reports with complete clinical data were included, while reviews, duplicate publications, and studies with incomplete information were excluded. A total of 16 eligible cases of CNS-TB complicated by DI were identified and analyzed. Results: A 54-year-old male patient presented with polydipsia, polyuria, headache, and loss of appetite. Laboratory investigations revealed low urine specific gravity and elevated plasma osmolality. A water deprivation test followed by desmopressin administration confirmed a diagnosis of central diabetes insipidus (CDI). Chest computed tomography (CT) demonstrated inflammatory changes in the right lung, accompanied by right-sided pleural effusion and secondary atelectasis of adjacent lung tissue. Magnetic resonance imaging (MRI) of the brain revealed thickening of the pituitary stalk, abnormal enhancement in the pituitary and pineal regions, and preserved hyperintensity in the posterior pituitary. The patient received diagnostic anti-tuberculosis therapy for three months but discontinued treatment on his own. Six months after discharge, repeat chest CT showed resolution of the pleural effusion, and pituitary MRI no longer showed abnormal findings; however, CDI persisted. A total of 16 additional cases of CNS-TB complicated by DI were identified through literature review, yielding 17 cases including the present report. Among these, 10 patients were male and 7 were female, with ages ranging from 5 to 63 years. Pulmonary tuberculosis was documented in 6 cases and subcutaneous nodular tuberculosis in 1 case. Imaging findings revealed sellar or suprasellar tuberculomas in 10 patients, pituitary stalk thickening in 7 patients, and cerebral edema in 2 patients. Six patients developed panhypopituitarism, and two had CDI accompanied by central hypothyroidism. Six patients with visual impairment underwent decompressive surgery, and one had visual field defects. During follow-up, CDI remained unresolved in 3 patients, hypothyroidism persisted in 1, and both adrenal insufficiency and hypothyroidism persisted in 2. All patients with visual acuity or field deficits showed clinical improvement. Imaging abnormalities resolved or regressed in 14 patients. Two patients died. Conclusion: CNS-TB may involve the sellar region, resulting in pituitary dysfunction and compression of the optic apparatus. Early assessment of pituitary function and regular follow-up are essential. Decompressive surgery should be considered in cases where visual function is threatened by mass effect.

Key words: Tuberculosis, central nervous system, Tuberculosis, meningeal, Diabetes insipidus

CLC Number:

Chen Fang, Zhao Yajun, Wang Rui, Feng Yanguo, Zhang Dezhi. A case of central nervous system tuberculosis with pituitary involvement and diabetes insipidus: A literature review[J]. Journal of Tuberculosis and Lung Disease , 2025, 6(5): 532-537. doi: 10.19983/j.issn.2096-8493.20250095

Figures/Tables 2

References 23

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