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| Article Title | Gender | Age | Patient Presentation | Type of Depression (Atypical or Typical) | Laboratory Findings (i.e. ACTH, Cortisol levels, Dexamethasone Test) | Radiologic Findings |
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| Posttraumatic Panhypopituitarism with Depression [10] | M | 38 | Features of MDD, irritability, decreased libido, nausea, headache, cold intolerance, constipation, malaise, arthralgia, somnolence, and reduced psychomotor activity | N/A | LH 1.7 mlU/mL, FSH 6.2 mlU/mL, testosterone 0.01 nmol/L, basal cortisol 0.23 μg/dL, PRL 0.28 ng/mL, free T3 1.3 pmol/L, free T4 1.1 pmol/L, TSH 0.06 mlU/L. | MRI: bilateral frontotemporal post traumatic encephalomalacia with gliosis and ex vacuo changes |
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| Psychiatric morbidity in adults with hypopituitarism [11] | M, F | 42.9
(mean) | GH deficiency, diabetes mellitus, major depression, and generalized anxiety disorder | 41 Pt: MDD | GH deficiency | N/A |
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| Sheehan's Syndrome Presenting as Major Depressive Disorder [12] | F | 45 | Generalized weakness, easy fatigability, loss of appetite, generalized body aches & pains and malaise. PMH included MDD and hypothyroidism | Atypical depression | Normocytic, normochromic anemia; cortisol 3.17 ug/dL, TSH 3.12 mIU/ml, FSH 3.00 mIU/l, LH 0.42 mIU/l, PRL 0.86 ng/ml, GH 0.22 ng/ml | MRI: empty sella |
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| Personality in patients with pituitary adenomas is characterized by increased anxiety-related traits: comparison of 70 acromegalic patients with patients with nonfunctioning pituitary adenomas and age- and gender-matched controls [13] | M, F | 45-70 | Group 1: neurotic, harm avoidant, reduced novelty seeking behavior, especially lower impulsiveness, and high social conformity
Group 2: neurotic and harm avoidant | N/A | Group 1: pituitary adenomas with acromegaly
Group 2: nonfunctioning pituitary adenomas | Group 1: global enlargement of the grey matter |
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| The impact of treatment on HPA axis activity in unipolar major depression [14] | M, F | 31-57 (mean 46.33) | Unipolar major depression | 1049 Pts: MDD, atypical depression and melancholic features | No changes in cortisol and ACTH levels before and after the treatment with antidepressants (56% of the patients) | N/A |
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Neuropsychiatric Manifestations in a Patient with Panhypopituitarism
[15] | M | 68 | Agitation and aggressive behavior, disheveled, grossly disorganized speech
& behavior, tangential thought process, lacked associational quality, delusions of paranoia & grandiosity, and rife
with religious themes | Schizophrenia | CBC, kidney, liver function tests and urine toxicology within normal limits | MRI: prominent ventricles, subarachnoid spaces suggest gross atrophy, opacification of the left sphenoid sinus, transsphenoidal resection of the right lobe of the pituitary gland |
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| Apathy and Pituitary Disease: It Has Nothing to Do with Depression [16] | Pt 1: M
Pt 2: F
Pt 3: F
Pt 4: F | Pt 1: 48
Pt 2: 55
Pt 3: 47
Pt 4: 36 | Pt 1: memory loss, concentration & attention problems
Pt 2: memory problems, difficulty with expression, fatigue, depressed feelings, unmotivated, and intermittent suicidal thoughts
Pt 3 & 4: lack of energy and motivation | Apathy syndrome | Pan-hypopituitarism after surgery to treat pituitary tumor | N/A |
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| Increased adrenocorticotropic hormone levels predict severity of depression after six months of follow-up in patients in outpatients with major depressive disorder [17] | M, F | 30-60 | MDD | 199 Pt: MDD | Patients with higher levels of ACTH at baseline were still depressed after treatment with SSRI, SNRI, and NaSSA | N/A |
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| Atypical depression in growth hormone deficient adults, and the beneficial effects of growth hormone treatment on depression and quality of life [18] | 16 M,
9 F | 18-59 (mean 38.4) | Social isolation, decreased energy, sleep disturbances, pain, and mobility problems | 25 Pt: typical or atypical depression | GH deficiency | N/A |
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| Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression [19] | M, F | 18-65 | Melancholic features of depression | Atypical depression compared to melancholic depression | Melancholic depression shows hyperactivity of the Hypothalamic-Pituitary-Adrenal axis. Atypical depression is associated with hypofunctioning of the axis, inflammation and metabolic abnormalities | N/A |
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| Biomarkers for Depression: Recent Insights, Current Challenges and Future Prospects [20] | M, F | N/S | MDD, treatment resistant depression, and atypical depression | MDD | Cortisol hyperactivity, overproduction of ACTH & CRH, and hypothyroidism. Inflammatory findings in depression including IL-6, IL-8; circadian rhythm changes | Reduced grey matter volume in hippocampal, prefrontal cortex, and basal ganglia regions |
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| Depression and Hypothalamic-Pituitary-Adrenal Activation: A Quantitative Summary of Four Decades of Research [21] | M, F | 18-75 | Minor depression, anhedonia, psychotic depression | Atypical depression compared to nonatypical depression | Atypical depression shows lower levels of cortisol, ACTH, and CRH | Reduced grey matter volume in hippocampal, prefrontal cortex, and basal ganglia regions |
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| Detection of Growth Hormone Deficiency in Adults with Chronic Traumatic Brain Injury [22] | M, F | 41-43 (age at time of injury) | Memory and concentration impairments, decreased quality of life, anxiety, depression, social isolation, hyperlipidemia, weight gain, osteoporosis, and exercise intolerance | 235 Pt: moderate depression | Hypopituitarism, especially GH deficiency and insufficiency, and testosterone deficiency | N/A |
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| Cognitive effects of pituitary tumours and their treatments: two case studies and an investigation of 90 patients [23] | Pt 1: F
Pt 2: F
90 Pt: M, F | Pt 1: 52
Pt 2: 63
90 Pt: 18-70 | Pt 1: lethargic, easily fatigability, depressed mood, irritability, sleep and appetite disturbances
Pt 2: hirsutism, mood change, cushingoid physical features, and memory loss | N/A | Pt 1: GH deficiency after radiation therapy to treat a pituitary adenoma
Pt 2: Pan-hypopituitarism after trans-sphenoidal hypophysectomy to treat a pituitary adenoma | Pt 1: MRI- displacement of the optic chiasm, deformation of the third ventricle, and some lateral spread on the right side.
Pt 2: MRI- no pathologies outside of the pituitary region |
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| Neuropsychiatric Disturbances and Hypopituitarism after Traumatic Brain Injury in an Elderly Man [24] | M | 77 | Frontotemporoparietal subdural and subarachnoid hemorrhage after a traumatic brain injury. 2 months later, complained of headaches, dizziness, memory loss, visual and auditory hallucinations, and depressive symptoms. Symptoms improved with prednisone and levothyroxine | N/A | Pan-hypopituitarism. | N/A |
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| Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress [25] | 39 M,
28 F | 38.8
(mean) | Patients with hormone deficiency presented with mild-moderate depression, anxiety, and psychoticism | 8 Pt: severe depression
11 Pt: mild to moderate depression | GH deficiency (9% of patients) and Gonadotropin deficiency (9% of patients) | MRI: hypoxic-ischemic brain damage in neonatal brain injury
PET scan: cortical asymmetry as well as hypometabolism |
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| Pathophysiologic Aspects of Major Depression following Traumatic Brain Injury [26] | N/S | N/S | MDD, also including anxiety, substance use disorder, and unusual aggressive behavior | MDD and anxiety | GH deficiency, which was absent in the chronic stage of TBI and may have been associated with excessive fatigue, emotional disturbance, and lack of motivation | Major depression was associated with reduced gray matter volume in the lateral aspects of the left prefrontal cortex. |
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| Chronic hypopituitarism after traumatic brain injury [27] | M, F | 14-80 (mean 32) | Patients with major abnormal hormone deficiency had worse Disability Rating Scale score, depression, and quality of life in terms of energy, fatigue, emotional well-being, and general health | N/A | GH deficiency and insufficiency | CT: increased abnormal acute findings in patients with major hormonal deficiency |
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| Complications after transsphenoidal surgery: our experience and a review of the literature [28] | N/S | N/S | Adenoma, acromegaly, Cushing’s disease, prolactinoma, Rathke’s cleft cyst, FSH secreting adenoma, granulomatous hypophysitis | Melancholic and atypical depression | Postoperative level of GH (<2 ng/l); postoperative level of serum cortisol (<50 nmol/l) | Postoperative CSF leak, thalamic infarct, hydrocephalus |
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| Pituitary insufficiency after traumatic brain injury [29] | 53 Pt
(64.1% M) | 45.2 ± 20.1 years,
45 (median) | Neuropsychological changes, like depression and anxiety, correlated more with the hemorrhagic lesions from brain injury compared to hypopituitarism | N/A | Cortisol, insulin-like growth factor 1, free thyroxine, estradiol, and testosterone were measured and showed pituitary insufficiency (25.4% of patients) | CT: skull fractures (61.5% of patients), one or more subarachnoid or intracerebral hemorrhagic lesions (73% of patients) |
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| Hypopituitarism following brain injury: when does it occur and how best to test? [30] | N/S | N/S | Headache, irritability, loss of memory, attention deficit, depression, fatigue, low working capability, and cognitive changes | 749 Pt: atypical depression | GH deficiency and low cortisol levels | MRI: hemorrhagic lesions |
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