Pituitary adenoma mimicking a psychiatric disorder a case report
Joana Mesquita1,2, Maria João Matos1,2, Ana Varela1,2, Eduardo Vinha1, Daniel Braga1,2, Fernanda Guerra1, Josué Pereira1, Margarida Ayres Bastos1, Lígia Castro1, Davide Carvalho1,2 & José Luís Medina1,2
Introduction: People with intracranial organic lesions, including pituitary tumours, may manifest initially as a psychiatric disorder, such as depression, emotional disturbance, anxiety, apathy, neurobehavioral disturbance, cognitive dysfunction and personality disturbance.
Case Report: A male patient 45 years old was sent to the Department of Endocrinology of São João Hospital due to a pituitary macroadenoma. The patient referred asthenia, muscle weakness, behaviour alteration and depression since about 3 years; reduced left visual acuity since about 2 years. He was followed since about 3 years in the Department of Neurology due to Parkinson diease and in the Department of Psychiatry because of dementia and behaviour alteration. In the physical exam, he had apathy and slow psychomotor skills. He performed a pituitary MRI that showed a big expansive intracranial lesion in the sellar region, invading the sphenoid sinus inferiorly and the suprasellar cistern superiorly. It caused compression of the optic chiasm, deviation of the left anterior cerebral artery and also invaded the cavernous sinus. It was T1 isointense and had a slight T2 hyperintensity. It had an uniform uptake of the contrast. In the biochemical evaluation, it was detected hypopituitarism in the basal and dynamic endocrine tests. It was initiated treatment with hydrocortisone (10 mg+5 mg) and levothyroxine 25 μg/dia.
The patient was submitted to a transsphenoidal pituitary surgery and the histology showed it was a pituitary adenoma with a slight expression of LH.
Conclusion: Patients with psychiatric manifestation often have delayed organic lesion diagnosis. The presented case report highlights the importance of the doctor evaluate the patient as a whole and be aware for the beginning of new symptoms, even in a patient who has been diagnosed a psychiatric disturbance.