PMC10174326_01
Flowchart of diagnoses and treatment. GAD, generalized anxiety disorder; MDE, major depressive episode; ECT, electroconvulsive therapy; ACTH, adrenocorticotropic hormone.
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fig1
Electroconvulsive therapy and a variety of medications were utilized to treat major depressive episode with nihilistic delusion, as shown in Figure 1.
Head MRI. On the right side of the pituitary gland, the pituitary microadenoma, appears as a nodular lesion with a hypointense signal on sagittal T1-and coronal T2-weighted pre-enhanced MRI images, and demonstrates delayed hyperenhancement on dynamic sequences.
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fig2
After presenting to the Department of Endocrinology, the patient underwent an enhanced MRI of the head and found a microadenoma 0.3 cm in diameter to the right side of the lower pituitary gland, as shown in Figure 2.
Trajectories of cortisol and ACTH. ACTH, adrenocorticotropic hormone. CK, creatine kinase.
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fig3
The trajectories of serum cortisol, ACTH, and creatine kinase are shown in Figure 3.