Reversible Tumorous Pituitary Enlargement due to Primary Hypothyroidism

Abstract

A 34-year-old man presented with history of intermittent throbbing frontal headache of 3 months duration. A week prior to presentation he had an episode of severe headache associated with nausea and vomiting, requiring hospitalization and parenteral analgesics. Magnetic resonance imaging (MRI) of the brain done detected a pituitary macroadenoma and he was referred to the Endocrinology Department for clearance prior to surgery. On questioning he also gave history of cold intolerance, weight gain despite poor appetite, easy fatigability, and hoarseness of voice for the past year. He had a puffy face and spoke in a hoarse voice. He also had sinus bradycardia, diastolic hypertension, non-pitting pedal edema, and delayed relaxation of deep tendon jerks. The thyroid gland was not palpable.