Secondary hypothyroidism following head trauma in a cat

2005 ◽  
Vol 7 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Richard J Mellanby ◽  
Nic D. Jeffery ◽  
Matt S Gopal ◽  
Michael E. Herrtage
Keyword(s):  
Head Trauma ◽  
Sella Turcica ◽  
Thyroid Stimulating Hormone ◽  
Magnetic Resonance Images ◽  
Empty Sella ◽  
Presumptive Diagnosis ◽  
Stunted Growth ◽  
Low Concentrations ◽  
Secondary Hypothyroidism ◽  
Open Physis

An 18-month-old female neutered domestic short hair cat was examined because of marked polydipsia and stunted growth following head trauma when it was 8 weeks old. Diagnostic evaluation revealed hyposthenuric urine, low concentrations of thyroid hormone and undetectable thyroid stimulating hormone concentrations which did not rise following thyroid releasing hormone administration. Lateral radiographs of the left and right tibiae revealed incomplete mineralisation of the greater tubercle and open physis. An almost empty sella turcica and a greatly reduced pituitary were visible on magnetic resonance images of the brain. A presumptive diagnosis of secondary hypothyroidism and central diabetes insipidus following head trauma was made.

Misleading normal TSH and persistently elevated creatine kinase: clues to the diagnosis of chronic Sheehan’s syndrome

2021 ◽  
Vol 14 (8) ◽  
pp. e243992
Author(s):  
Ayşe Y Demir ◽  
Christine P Oldenburg-Ligtenberg ◽  
Bianca Loredana Toma-Stan ◽  
Albert van de Wiel
Keyword(s):  
Creatine Kinase ◽  
Postpartum Haemorrhage ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Reference Interval ◽  
Thyroid Stimulating Hormone ◽  
Empty Sella ◽  
Sheehan’S Syndrome ◽  
Elevated Creatine Kinase ◽  
Sheehan's Syndrome

A 53-year-old woman was referred for medical evaluation of therapy-resistant dyslipidaemia accompanied by elevated creatine kinase levels. Because cessation or alteration of her medication did not improve laboratory abnormalities, hypothyroidism was considered, despite the fact that thyroid stimulating hormone levels were within the reference interval. On further evaluation, she was found to have panhypopituitarism and empty sella turcica as shown by MRI. These findings were unexpected since there was no clinical suspicion during detailed evaluation. When supplementary questions were asked, she brought up a history of severe postpartum haemorrhage 30 years ago, for which she underwent a hysterectomy. Based on these findings, the patient was diagnosed with Sheehan’s syndrome. This syndrome is a rare but potentially life-threatening complication of postpartum haemorrhage, characterised by varying degrees of hypopituitarism that are most commonly presented many years after delivery. The patient recovered after adequate hormone replacement therapy.

Reversible visual deficit following debulking of a Rathke's cleft cyst: a tethered chiasm?

1994 ◽  
Vol 81 (3) ◽  
pp. 459-462 ◽  
Author(s):  
Edwin G. Fischer ◽  
Umberto DeGirolami ◽  
James N. Suojanen
Keyword(s):  
Sella Turcica ◽  
Magnetic Resonance Images ◽  
Empty Sella ◽  
Anatomical Location ◽  
Rathke’S Cleft Cyst ◽  
Optic System ◽  
Rathke's Cleft Cyst ◽  
Anterior Portion ◽  
Content Type ◽  
Rathke's Cleft

✓ Delayed chiasmal syndromes after emptying of a Rathke's cleft cyst have not been reported previously. When these deficits occur following the treatment of parasellar lesions they are usually associated with the descent of a scarred optic system into an empty sella, and vision often improves promptly when the optic system is elevated. Two months after transsphenoidal surgery with emptying of a large intrasellar cyst, a 22-year-old man developed recurrent bitemporal visual field deficits over a 3-day period. Sagittal magnetic resonance images demonstrated an enhancing band of tissue extending anteriorly from the normally placed chiasm down to the anterior portion of the sella turcica. At craniotomy the enhancing tissue was found to be scar extending from the anterior border of the chiasm to the diaphragma sellae. The anterior portion of the diaphragm was resected as widely as possible without dissecting the scar itself from the chiasm. A membrane consistent with the wall of a Rathke's cleft cyst was found attached to the resected tissue. The patient's vision was improved 2 days after surgery. This case illustrates that traction by scar extending from the chiasm to the diaphragm, even when the chiasm is in its normal anatomical location, may cause progressive visual loss; and that untethering of the chiasm by resecting the diaphragm while leaving the scar intact can result in improved vision.

scholarly journals A rare case of hypopituitarism with psychosis

2013 ◽  
Vol 2013 ◽  
Author(s):  
M Nwokolo ◽  
J Fletcher
Keyword(s):  
Adrenal Insufficiency ◽  
Fluid Resuscitation ◽  
Dynamic Testing ◽  
Rare Complication ◽  
False Negative ◽  
Sella Turcica ◽  
Empty Sella ◽  
Electrolyte Imbalance ◽  
List Type ◽  
Presumptive Diagnosis

Summary A 46-year-old woman presented multiple times in a 4-month period with hypotension, sepsis, hypoglycaemia and psychosis. A low random cortisol in combination with her presenting complaint made adrenal insufficiency the likely diagnosis. Fluid resuscitation and i.v. steroid therapy led to clinical improvement; however, a short synacthen test (SST) demonstrated an apparently satisfactory cortisol response. The test was repeated on a later admission and revealed a peak cortisol level of 25 nmol/l (>550 nmol/l). Concurrent treatment with i.v. hydrocortisone had led to a false-negative SST. ACTH was <5 ng/l (>10 ng/l), indicating secondary adrenal failure. We discuss the challenges surrounding the diagnosis of adrenal insufficiency and hypopituitarism, the rare complication of psychosis and a presumptive diagnosis of autoimmune lymphocytic hypophysitis (ALH). Learning points Adrenocortical insufficiency must be considered in the shocked, hypovolaemic and hypoglycaemic patient with electrolyte imbalance. Rapid treatment with fluid resuscitation and i.v. corticosteroids is vital. Polymorphic presentations to multiple specialities are common. Generalised myalgia, abdominal pain and delirium are well recognised, psychosis is rare. A random cortisol can be taken with baseline bloods. Once the patient is stable, meticulous dynamic testing must follow to confirm the clinical diagnosis. The chronic disease progression of ALH is hypothesised to be expansion then atrophy of the pituitary gland resulting in empty sella turcica and hypopituitarism. If hypopituitarism is suspected, an ACTH deficiency should be treated prior to commencing thyroxine (T4) therapy as unopposed T4 may worsen features of cortisol deficiency.

Pituitary abscesses

1977 ◽  
Vol 46 (5) ◽  
pp. 601-608 ◽  
Author(s):  
James N. Domingue ◽  
Charles B. Wilson
Keyword(s):  
Bacterial Meningitis ◽  
Preoperative Diagnosis ◽  
World Literature ◽  
Sella Turcica ◽  
Visual Field Defects ◽  
Pituitary Abscess ◽  
Presumptive Diagnosis ◽  
Content Type ◽  
Purulent Meningitis ◽  
Fine Print

✓ Seven cases of pituitary abscess are presented and the relevant world literature is reviewed. An enlarged sella co-existing with bacterial meningitis, or bacterial meningitis coinciding with a known or suspected pituitary tumor should suggest the diagnosis of pituitary abscess. Visual field defects should evoke similar suspicion when present in a patient with meningitis. This reasoning enabled us to make the first reported preoperative diagnosis of pituitary abscess. Therefore, in the management of purulent meningitis, we recommend the following: first, skull films are mandatory; second, if the sella turcica is abnormal, the correct presumptive diagnosis is pituitary abscess; and third, if prompt improvement does not follow appropriate antibiotic therapy, the suspected abscess should be explored and drained via the transsphenoidal approach.

The potentials of magnetic resonance tomography in the diagnosis of the “empty” sella turcica

1994 ◽  
Vol 24 (3) ◽  
pp. 229-233 ◽  
Author(s):  
I. I. Dedov ◽  
T. S. Zenkova ◽  
G. A. Mel'nichenko ◽  
O. I. Belichenko ◽  
I. D. Fedina
Keyword(s):  
Magnetic Resonance ◽  
Sella Turcica ◽  
Magnetic Resonance Tomography ◽  
Empty Sella

THE PRIMARY EMPTY SELLA AN ENDOCRINE STUDY ON 12 CASES

1976 ◽  
Vol 83 (3) ◽  
pp. 483-492 ◽  
Author(s):  
G. Schaison ◽  
J. Metzger
Keyword(s):  
Prolactin Level ◽  
Sella Turcica ◽  
Empty Sella ◽  
Endocrine Function ◽  
Thyrotrophin Releasing Hormone ◽  
Releasing Hormone ◽  
Group A ◽  
Group B ◽  
Lh Releasing Hormone ◽  
Primary Empty Sella

ABSTRACT Twelve patients (10 women and 2 men) with a primary empty sella turcica were studied. Endocrine function tests were performed as follows: growth hormone (GH) was measured after insulin-induced-hypoglycaemia, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) after LH-releasing hormone, thyrotrophin (TSH) and prolactin after thyrotrophin-releasing hormone; pituitary reserve of adrenocorticotrophin (ACTH) was determined by measurement of plasma cortisol after lysinevasopressin and 11 deoxycortisol after metyrapone. Five of the patients (group A) had no endocrine disturbance. Seven patients (group B) had a hypothalamo-pituitary disorder. Two of them had panhypopituitarism which appeared in one case after meningoencephalitis and in the other after a severe cranial trauma. In two cases an amenorrhoea-galactorrhoea syndrome with increased prolactin level (68 and 230 ng/ml) led to a diagnosis of a prolactin producing adenoma, which was confirmed by surgery. Finally three cases of amenorrhoeagalactorrhoea, with normal prolactin level, and/or diabetes insipidus remained unexplained. However, no causal relationship could be demonstrated between the pituitary disturbance and the "empty sella". Primary empty sella turcica is therefore a neuroanatomical and neuroradiological entity with no endocrine implication. A pituitary disorder might suggest a microadenoma or an incidentally associated disease.

scholarly journals Anterior pituitary lobe atrophy as late complication of hemorrhagic fever with renal syndrome

2009 ◽  
Vol 66 (2) ◽  
pp. 166-168
Author(s):  
Dragan Jovanovic ◽  
Zoran Kovacevic ◽  
Tamara Dragovic ◽  
Marijana Petrovic ◽  
Jelena Tadic
Keyword(s):  
Renal Insufficiency ◽  
Anterior Pituitary ◽  
Late Complication ◽  
Sella Turcica ◽  
Hemorrhagic Fever ◽  
Empty Sella ◽  
Acute Stage ◽  
Hantavirus Infection ◽  
Multisystemic Disease ◽  
Acute Renal Insufficiency

Introduction. Hemorrhagic fever with renal syndrome (HFRS) is acute infective multisystemic disease followed by febrility, hemorrhages and acute renal insufficiency. Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of HFRS, while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. Case report. We presented a patient with the development of chronic renal insufficiency and hypopituitarism as complication that had been diagnosed six years after Hantavirus infection. Magnetic resonance of the pituitary gland revealed atrophy and empty sella turcica. Conclusion. Regarding frequency of this viral infection and its endemic character in some parts of our country partial and/or complete loss of pituitary function should be considered during the late stage of HFRS.

Primary hypothyroidism associated with empty sella turcica and hypopituitarism

2021 ◽  
Author(s):  
Chayma Besrour ◽  
Imen Rojbi ◽  
Youssef Lakhoua ◽  
Nadia Mchirgui ◽  
Ibtissem Ben Nacef ◽  
...  
Keyword(s):  
Sella Turcica ◽  
Empty Sella ◽  
Primary Hypothyroidism

scholarly journals Evaluation of pituitary function in cases with the diagnosis of pediatric mild traumatic brain injury: Cross-sectional study

2016 ◽  
Vol 7 (04) ◽  
pp. 537-543 ◽  
Author(s):  
Hakan Aylanç ◽  
Filiz Tütüncüler ◽  
Necdet Süt
Keyword(s):  
Head Trauma ◽  
Early Period ◽  
Serum Cortisol ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Cross Sectional ◽  
Pituitary Dysfunction ◽  
Duration Time ◽  
Basal Cortisol Level ◽  
Stimulating Hormone

ABSTRACT Background: This study was to determine whether pituitary dysfunction occurs after head trauma in children or not and which axis is affected more; to define the association of pituitary dysfunction with the severity of head trauma and duration time after the diagnosis of head trauma. Materials and Methods: In this study, 24 children who were diagnosed with head trauma were evaluated regarding pituitary dysfunction. In all cases, after 12 h fasting, serum cortisol, fT3, fT4, thyroid-stimulating hormone, prolactin, insulin-like growth factor-1, serum sodium, urine density, follicle-stimulating hormone, luteinizing hormone, in female cases E2, in male cases, TT levels were determined. Results: Mean age of children was 9.5 ± 3.1 years, 14 children (58.3%) had mild, 9 children (37.5%) had moderate, and 1 children (4.2%) had severe head trauma according to the Glasgow coma scale. Mean duration time after head trauma was 29.4 ± 9.8 months. In all cases, no pathologic condition was determined in the pituitary hormonal axis. In one children (4.2%), low basal cortisol level was found. There were no children with hormonal deficiency in this study. Conclusion: Although pituitary dysfunction after head trauma may develop in the early period, some may present in the late period; therefore, all cases should be followed up at outpatient clinics for a longer period.

scholarly journals Septo-optic dysplasia

2010 ◽  
Vol 68 (3) ◽  
pp. 400-405 ◽  
Author(s):  
Karina de Ferran ◽  
Isla Aguiar Paiva ◽  
Daniel Luiz Schueftan Gilban ◽  
Monique Resende ◽  
Micheline Abreu Rayol de Souza ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Thyroid Stimulating Hormone ◽  
Empty Sella ◽  
Optic Nerve Hypoplasia ◽  
Brain Abnormalities ◽  
Development Delay ◽  
Congenital Condition ◽  
Pituitary Hypoplasia ◽  
De Morsier Syndrome ◽  
Congenital Hypopituitarism

Septo-optic dysplasia (SOD), also referred to as de Morsier syndrome, is a rare congenital condition, characterized by two of the classic triad features: midline brain abnormalities, optic nerve hypoplasia (ONH) and pituitary endocrine dysfunction. We report 5 children with SOD, originally referred to be evaluated due to short stature, who also presented bilateral optic nerve hypoplasia, nystagmus and development delay. In 4 of the patients, we identified neuroimaging abnormalities of the hypothalamo-pituitary axis such as anterior pituitary hypoplasia (3/5), ectopic posterior pituitary (4/5), thin or absent stalk (3/5) and empty sella (1/5). We also encountered diverse pituitary deficiencies: growth hormone (3/5), adrenocorticotropic hormone (3/5), thyroid-stimulating hormone (2/5) and antidiuretic hormone (1/5). Only one child presented intact pituitary function and anatomy. Although rare, SOD is an important cause of congenital hypopituitarism and it should be considered in children with optic nerve hypoplasia or midline brain abnormalities for early diagnosis and treatment.

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