Tuberculosis of the sella masquerading as pituitary adenoma

Tuberculosis of the central nervous system is an ominous consequence of disseminated tuberculosis which usually manifests as meningitis, an abscess or rarely as a tuberculoma. Though infrequent, intracranial tuberculomas especially within the sella, are notorious for simulating as pituitary tumors, by jeopardising pituitary hormonal function and exerting compressive effects on adjacent intracranial structures. However, a prompt evaluation can help tackle this diagnostic challenge with timely institution of anti-tuberculosis treatment, (ATT). Although in rare instances surgery may be a favourable option especially for managing extensive intrasellar masses, ATT usually facilitates resolution of such lesions. Long term hormonal replacement therapy may be required for established endocrine dysfunction.