Pituitary adenoma with hypothalamic involvement: a case of ‘atypical’ atypical depression

Pituitary tumours are known to be associated with neuropsychiatric manifestations; however, it is uncommon for the manifestations to be the sole presenting symptoms. We report a case of 29-year-old male presenting with low mood, decreased attention, forgetfulness, increased sleep, and increased appetite of three months duration. Diagnosis of moderate depression episode with atypical features was considered and started on antidepressant Bupropion up to 300 mg/day to which he showed no improvement. Considering the atypical features and poor response to antidepressants, magnetic resonance imaging (MRI) brain was done which showed pituitary macro adenoma compressing on the hypothalamus. After surgical removal of the tumour, patient's symptoms improved. Hypothalamic involvement in this patient possibly led to manifestations mimicking atypical depression. This case highlights the importance of considering organic aetiologies in patients presenting with atypical depression.