Background and study aim: Hypopituitarism has been reported in about 20% of patients, even years after recovery from tuberculous meningitis (TBM) in childhood. Pituitary involvement is a significant complication of TBM and clinicians should be aware of the potential involvement of the pituitary gland in TBM cases. The study aimed to determine changes in pituitary hormone levels in newly diagnosed TBM cases.
Patients and Methods: A cross-sectional, observational study, included all adult admitted cases diagnosed as TBM based on Ahuja criteria. Clinical features of the included cases were noted. Analysis of CSF and pituitary hormone levels, imaging like CT scan brain and where possible MRI were done. Data was statistically analysed.‎
Results: Out of the 40 TBM cases, 2 were definite cases with CSF CBNAAT being positive, 10 were highly probable and rest 28 were probable as per modified Ahuja criteria. Lumbar puncture was done in all cases and CSF analysed. CSF analysis showed > 20 cells in 35 cases and for all such cases CSF protein was raised, sugar was low. 38 TBM cases had suggestive neuroimaging, where basal exudates and gyral enhancement were the most common radiological abnormality noticed. More than one hormone disbalance was noted in 9 cases. Serum cortisol and ACTH was low in 20% cases, while serum prolactin was high in 7.5% cases. SIADH was diagnosed in 15% cases. Testosterone was low in 3.7% males and FSH was low in 15.3% females. TSH and free T4 was low in 15% and 12.5% patients respectively. IGF-1 was low in only 5% patients. The involvement of pituitary hormones in TBM is not directly related to the disease itself but can occur as a consequence of the infection‎.
Conclusion: The specific impact on pituitary hormone function can vary depending on the severity and duration of the infection, as well as individual factors ‎.