tioning pituitary adenoma [1, 6]. Hypogonadotropic hypogonadism affects 40–75% of individuals with a nonfunctioning pituitary adenoma, and central hypothyroidism and hypocortisolism affect 20–40% of cases [1, 6]. Due to the tumor compressing the pituitary stalk and disrupting the descending dopaminergic effects, moderate hyperprolactinemia (100 mg/mL) can occur [1]. Pituitary apoplexy can occur in 8–10% of pituitary adenomas [6]. The patient in this case had unusual symptoms of a nonfunctioning pituitary macroadenoma. She had recurrent episodic vomiting. The patient had generalized body weakness with loss of appetite, which could be generic hypoadrenergic symptoms. Our patient experienced a variety of psychologi­cal concerns, including the loss of her mother at a young age and the end of a rela­tionship recently. The patient linked the onset of all of her symptoms to the dissolution of her relationship, which occurred shortly after she started university. Having a number of psychosocial issues may cause clinicians to deviate from the proper diagnosis path. Although there may have been coexisting psychological dif­culties, it is necessary to rule out organic factors before making a psychological diagnosis. This case emphasizes the signicance of ruling out organic factors before reaching a psychiatric conclusion. Another uncommon symptom of a nonfunction­ing pituitary macroadenoma was severe hyponatremia, as seen in this patient. With a history of recurrent vomiting, it’s easy to mistake vomiting for the source of the electrolyte imbalance. Because there can be several underlying etiologies for an electrolyte imbalance, this instance emphasizes the signicance of thoroughly ana­lyzing it. When examining chronic or persistent hyponatremia, a high index of sus­picion is required [8]. Hyponatremia is dened as a sodium level in the blood that is less than 135mmol/L.When serum sodium falls below 125mmol/L, severe hypo­natremia develops, which is linked to increased morbidity and death [8] and must be investigated thoroughly. Secondary hypoadrenalism rather than central hypothy­roidism is the commonest cause of hyponatremia caused by hypopituitarism [9]. In the absence of normal cortisol action in the kidney, hyponatremia related to second­ary hypoadrenalism is produced by reduced electrolyte-free water excretion [9]. Higher secretion of arginine vasopressin, a secondary adrenocorticotropic hormone (ACTH) secretagogue, results in increased urine concentration and can worsen hyponatremia [9]. Hypothyroidism causes changes in renal perfusion and a reduc­tion in glomerular ltration. The inability to eliminate free water causes hyponatre­mia in hypothyroidism. The hormone arginine vasopressin has an effect on urine dilution. Hypothyroidism produces hyponatremia because a lower glomerular ltra­tion rate reduces water supply to the tubules, lowering free water excretion [9].