Expert opinion: Headache and pituitary tumors.

CASE 1 A 37-year-old woman was seen with a chief complaint of new onset headaches for 2 months without any prior history of significant headaches. She described a generalized throbbing and aching pain with an intensity of 10/10 associated with light and noise sensitivity and blurred vision in both eyes but no nausea or aura lasting about 3-4 hours with ibuprofen but then recurring requiring another dose of medication. The headaches were occurring about every other day. She was not aware of any triggers. Past medical history was negative. Menses are regular. No history of galactorrhea. Family history was negative for migraine. Neurological examination was normal. Examination by an ophthalmologist including visual fields was normal. A magnetic resonance imaging (MRI) of the brain and later an MRI of the pituitary with and without contrast revealed a nonhemorrhagic cystic macroadenoma of the left side of the pituitary gland with a small degree of extension to the left suprasellar cistern and displacement into the left side of the sphenoid sinus with remodeling of the floor of the sella turcica abutting but not invading the left cavernous sinus and abutting but not encasing the supraclinoid left internal carotid artery. The adenoma measured 1.3 cm in craniocaudal dimension and 1.1 cm in transverse size with deviation of the infundibulum to the right inferiorly. There was no contact or deformation of the optic chiasm or left optic nerve or tract. The following blood tests were normal: thyroid stimulating hormone, free T-4, follicle stimulating hormone, luteinizing hormone, prolactin, adrenocorticotrophic hormone, and insulin-like growth factor-I.