We report a case of 15-year-old girl who was diagnosed as a case of pituitary macroadenoma on computed tomography and magnetic resonance imaging (MRI) scans for her complains of
diminished vision in the left eye and
headache. On investigation she was found to have
optic atrophy of left eye and
primary hypothyroidism. She was started on
thyroxin therapy in October 2008 and planned for transcranial excision of the
tumor. Just before the date for planned surgery she developed mildly itchy vesico-bullous
rash and the surgery was postponed. On histopathology and immunoflourescence studies it was confirmed to be the
rash of
dermatitis herpetiformis (DH) and treatment was started with
corticosteroids in the last week of December 2008 and
dapsone was added from mid January 2009. The lesions responded dramatically and within 6 weeks of starting treatment, she had become asymptomatic except for persisting diminution of vision. Repeat MRI scans in mid-February 2009 revealed total regression of pituitary mass. The case is being reported for interesting association of
primary hypothyroidism, pituitary mass mimicking macroadenoma and DH; its successful outcome with medical management in the form of total regression of pituitary mass, thereby avoiding an unnecessary surgery.