Nummular headache and pituitary lesion: A case report and literature review
A 54-year-old woman was diagnosed the Behçet’s disease (BD) for more than 10 years and was remitted in recent 2 years. Since, 1 year ago, she suffered from a cyclic recurrence of headache; the pain was mild to moderate in intensity, lancinating or electric in nature, exclusively, located at vertex and left parasagittal area, circular in shape, 3.0 cm × 3.0 cm in size, and exhibited a clear-cut boundary from non-painful surrounding. It peaked and subsided spontaneously. There was no aura before or associated discomfort during attack. The severity of pain was intensified when she combed the hair or touched the painful area during pain attack. The intensity of pain did not significantly fluctuate substantially. In recent 1 month, she found herself easy for hitting objects at either side during walking without unsteadiness. She denied antecedent craniofacial trauma, migraine, herb or supplement usage, or consumption of alcohol or cigarette before.\nOn presentation, her vital signs were stable. She described her pain being continuing for 3 days without remission and also she was oriented and co-operative. Visual field showed a defect at the lateral part of temporal visual fields at both sides, or an incomplete chiasmal visual defect. No papilledema was seen. Neurological examination did not reveal abnormal finding. Within the painful area, there was no trophic change, erythema, or edema; however, mild hyperesthesia to pinprick pain was detected. When the hair was stretched or scalp was pressed, pain was exacerbated. Temporal artery was not tender or engorged. Bruit was not heard. Percussion pain was not elicited at temporomandibular joint, sinus or cervical spine. Clinically, her headache was not compatible with migraine, tension headache, non-structural headache of Behçet, or any known primary or secondary headache disorder.[] Finally, NH was interpreted.\nHead magnetic resonance imaging revealed a huge mass at the suprasellar region [Figure and ]. The serum adenohypophyseal hormones were within reference range. Trans-sphenoidal microsurgery was performed after consent. Pathological study revealed adenoma cells with weakly eosinophilic staining. Immunohistochemical staining did not disclose a positive staining of prolactin, growth hormone, corticotropin, thyrotropin, or gonadal hormones. Electro microscopy showed a few secretory vesicles whereas an abundance of intracellular mitochondria [], compatible with non-functional oncocytoma. Patient subjectively, stated that the intensity and frequency of pain rapidly subsided after surgical procedure. On a follow-up of 6 years, headache did not recur.