Behavioral Changes Following Traumatic Brain Injury and Neurosurgery for Incidental Pituitary Macroadenoma: A Case Report

Abstract

Traumatic brain injury (TBI) is a leading cause of long-term disability, affecting approximately 69 million individuals annually, with survivors disproportionately affected by chronic neuropsychiatric complications. A coexisting pituitary macroadenoma may further compound psychiatric morbidity through mass effect, hypothalamic compression, and disruption of adjacent limbic structures. We report the case of a 29-year-old male who sustained TBI with loss of consciousness. Neuroimaging revealed intracranial hematomas alongside an incidentally identified pituitary macroadenoma. He developed progressive behavioral changes, irritability, verbal aggression, social withdrawal, and incongruent affect, followed by visual disturbances necessitating endoscopic endonasal trans-sphenoidal excision. Behavioral symptoms markedly worsened postoperatively, with psychotic features and mild cognitive impairment (Montreal Cognitive Assessment: 21/30). Olanzapine yielded approximately 70% improvement in behavioral changes. Structured cognitive–behavioral therapy and psychoeducation were subsequently initiated; residual cognitive and functional deficits persisted. This case illustrates a compounding neuropsychiatric interaction in which TBI, concurrent pituitary pathology, and neurosurgical intervention converged to produce a syndrome of disproportionate severity, underscoring the need for early psychiatric involvement and multidisciplinary rehabilitation.