Presence of anti-pituitary hormone antibodies in patients with empty sella syndrome and pituitary tumours

1993 ◽  
Vol 38 (5) ◽  
pp. 495-500 ◽  
Author(s):  
Marjorie Mau ◽  
Terry M. Phillips ◽  
Robert E. Ratner
Keyword(s):  
Empty Sella ◽  
Pituitary Hormone ◽  
Pituitary Tumours ◽  
Empty Sella Syndrome

scholarly journals Radiographic pituitary stalk disruption: A rare sequela of secondary empty sella syndrome

2021 ◽  
Vol 12 ◽  
pp. 385
Author(s):  
Evan Winograd ◽  
Michael W. Kortz ◽  
Kevin O. Lillehei
Keyword(s):  
Case Series ◽  
Empty Sella ◽  
Pituitary Stalk ◽  
Pituitary Hormone ◽  
Empty Sella Syndrome ◽  
Normal Pituitary Gland ◽  
Rare Manifestation ◽  
Potential Risk Factors ◽  
Patients At Risk ◽  
Transsphenoidal Resection

Background: This two-patient case series describes a rare sequela of postoperative empty sella syndrome (ESS) following transsphenoidal resection of pituitary macroadenomas. This is characterized by progressive hormone dysfunction, diabetes insipidus (DI), and associated MRI evidence of pituitary stalk disruption. Case Description: This phenomenon was retrospectively evaluated in a review of 2000 pituitary tumor resections performed by a single neurosurgeon (KOL). Chart review was retrospectively conducted to gather data on demographics, pituitary hormone status, tumor characteristics, and management. We identified 2 (0.1%) cases of progressive pituitary endocrine dysfunction occurring in the postoperative period associated with MRI evidence of pituitary stalk disruption within 6 weeks of discharge from the hospital. This was felt to be caused by the rapid descent of the residual normal pituitary gland down to the floor of the postoperative empty sella, causing relatively swift stalk stretching. Both patients developed DI, and one patient demonstrated increased pituitary hormone dysfunction. Conclusion: This phenomenon is a rare manifestation of postoperative ESS, secondary to surgical resection of a pituitary macroadenoma. We discuss the associated potential risk factors and strategies for avoidance in these two cases. Routine instillation of intrasellar fat in patients at risk is felt to be protective.

scholarly journals An Unusual Case of Acute Adrenal Insufficiency

2013 ◽  
Vol 1 (2) ◽  
pp. 107-108
Author(s):  
Chanchal Das ◽  
Pranab Kumar Sahana ◽  
Nilanjan Sengupta ◽  
Mukut Roy ◽  
Ranen Dasgupta
Keyword(s):  
Adrenal Insufficiency ◽  
Unusual Case ◽  
Empty Sella ◽  
Pituitary Hormone ◽  
Empty Sella Syndrome ◽  
Acute Adrenal Insufficiency ◽  
Levothyroxine Replacement ◽  
Rule Out

Empty Sella Syndrome (ESS) may be asymptomatic or manifested as features of multiple pituitary hormone deficiencies. In a patient of suspected hypopituitarism, multiple pituitary hormonal axes should be tested to rule out concomitant hormones deficiencies. In Hypopituitarism, treatment of hypoadrenalism should be undertaken first before giving levothyroxine replacement to prevent adrenal insufficiency. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17206 Bangladesh Crit Care J September 2013; 1 (2): 107-108

Primary hypothyroidism associated with empty sella turcica and hypopituitarism

2005 ◽  
Vol 58 (7-8) ◽  
pp. 410-413 ◽  
Author(s):  
Maja Milosevic ◽  
Milos Stojanovic ◽  
Milica Nesovic
Keyword(s):  
Sella Turcica ◽  
Pituitary Hormones ◽  
Empty Sella ◽  
Primary Hypothyroidism ◽  
Pituitary Hormone ◽  
Pituitary Insufficiency ◽  
Central Hypothyroidism ◽  
Empty Sella Syndrome ◽  
The Third ◽  
High Level

Introduction Empty sella syndrome is a rather frequent neuroradiological finding in the general population and can be associated with hypopituitarism. Examinations reveal low pituitary hormone levels and lack of response to stimuli. Most patients suffer from central hypothyroidism as part of pituitary insufficiency. Primary hypothyreoidism is a rare finding in these patients. Case report We present 3 patients: one female and two male, suffering from complete hypopituitarism, as part of the empty sella syndrome diagnosed due to low concentrations of all pituitary hormones, elevated TSH and low thyroid hormones. TRH, LHRH, ACTH and ITT tests, as well as IGF1 have confirmed hypopituitarism and primary hypothyroidism. CT and NMR in all three patients showed empty sella without a tumor in it. The diagnosis of primary hypothyrodism in the first patient was made before hypopituitarism has taken place, or at the same time in the second patient, whereas in the third patient it was diagnosed twenty years later. In two patients anti-TPO and anti-Tg antibody levels were high, and in the third patient they were not elevated. It can be assumed that the etiology of primary hypothyrodism in all three patients was of autoimmune origin, which caused thyroid hypofunction. High level of TSH in all three patients and especially in the patient whose hypopituitarism was diagnosed twenty years later, showed presence of thyrotrophic cells in the pituitary. Evaluation of the hypothalamic-pituitary-thyroid axis was carried out during the complete substitution therapy of hypopituitarism. Conclusion Diagnosing primary hypothyrodism associated with hypopituitarism helps improving the knowledge on empty sella syndrome and points to different clinical syndromes characterized by lack of mixoedema, although approach to therapy is the same for both primary and central hypothyroidism.

scholarly journals A Case with Empty Sella Syndrome Combined with Multiple Anterior Pituitary Hormone Deficiencies Presenting as Hypoglycemic Coma

2014 ◽  
Vol 29 (2) ◽  
pp. 151
Author(s):  
Soo Kyoung Kim ◽  
Sung Su Kim ◽  
Bo Ra Kim ◽  
Jung Hwa Jung ◽  
Jae Hoon Jung ◽  
...  
Keyword(s):  
Anterior Pituitary ◽  
Empty Sella ◽  
Pituitary Hormone ◽  
Empty Sella Syndrome ◽  
Hypoglycemic Coma ◽  
Anterior Pituitary Hormone

scholarly journals Rathke’s Cleft Cyst Abscess—An Unusual Guest in The Sella

2021 ◽  
Author(s):  
Piyush Lodha ◽  
Srinivas Rao P ◽  
Vijay Sheker Reddy Danda ◽  
Gollapudi Prakash Rao
Keyword(s):  
Visual Fields ◽  
Empty Sella ◽  
Abscess Formation ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Pituitary Mass ◽  
Empty Sella Syndrome ◽  
Rim Enhancement ◽  
Bitemporal Hemianopia

AbstractAbscess formation within a Rathkes’s cleft cyst (RCC) is extremely rare, particularly at a young age. We report the case of a young girl with abscess formation in RCC. A 21-year-old female presented with headache, vomiting, visual deterioration and features suggestive of hypopituitarism. She had bitemporal hemianopia with impairment of visual acuity. MRI revealed a cystic lesion in the sella with suprasellar extension and peripheral rim enhancement. On the basis of history and imaging, this was indistinguishable from more commonly encountered pituitary pathology. She underwent transsphenoidal decompression, which revealed yellowish purulent material that when cultured grew Staphylococcus epidermidis. Histological examination revealed numerous neutrophils and cyst wall lining with features characteristic of RCC. Postoperatively, she received antibiotics and replacement therapy for hypopituitarism. Three months later, she experienced deterioration in visual fields. Considering persistent disease, she underwent redo surgery which revealed similar findings. Postsurgery, pituitary MRI revealed an empty sella syndrome. Thereafter, follow-up for 1 year was stable with permanent diabetes insipidus and multiple pituitary hormone deficiency on supplementation. Although uncommon, we recommend considering RCC abscess as a differential diagnosis of a pituitary mass lesion, as predicting its presence can be difficult preoperatively. Persistent or recurrent disease is common in these cases, so timely diagnosis and adequate surgical drainage leads to lower morbidity and mortality.

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