Isolated neuropsychiatric features with non-functioning pituitary adenoma: Association or coincidence?

Non-functioning pituitary macroadenomas are often detected after a long latency period, with symptoms due to compression of adjacent structures (headache, visual field abnormality) and hyposecretion of pituitary hormones. Irrespective of endocrinal disturbances, these patients sometimes demonstrate mood abnormalities, cognitive deterioration, and psychotic symptoms, in such cases usually other symptoms prevail in the clinical picture. Only rare anecdotal case reports are available in which isolated neuropsychiatric or cognitive symptoms were the presenting features of pituitary adenomas. We report a 17-year-old boy with non-functioning pituitary macroadenoma, who presented with depressive symptoms for 6 months, along with predominantly mood-congruent psychotic features and anterograde memory impairment. On subsequent evaluation, he was found to have subclinical abnormalities in visual field testing. His endocrinological and other ancillary investigations were normal. He partially responded to multiple antidepressants and is currently being planned for surgical intervention. Hence, clinicians need to perform neuroimaging in cases with depressive symptoms, when the course is atypical, unsatisfactory response to multiple antidepressants, prominent psychotic/memory-related symptoms to rule out secondary causes. In such cases, pituitary adenomas should also be considered as one of the clinical differentials.