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

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.

2013 ◽  
Vol 1 (2) ◽  
pp. 107-108
Author(s):  
Chanchal Das ◽  
Pranab Kumar Sahana ◽  
Nilanjan Sengupta ◽  
Mukut Roy ◽  
Ranen Dasgupta

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


2020 ◽  
pp. 3-7

Background and aim Empty sella is the neuroradiological or pathological finding of an apparently empty sella turcica. The aim of the study was to analyze the clinical, hormonal and radiological characteristics of patients with empty sella and to compare anterior pituitary function in total versus partial primary empty sella. Methods The records of 36 patients with primary empty sella were retrospectively analyzed over a 24-years period. The patients were evaluated for pituitary function with basal hormone levels (FT4, TSH, IGF1, FSH, LH, cortisol, ACTH, prolactin) and dynamic testing when necessary. Results Our study included 26 women and 10 men with an average age of 47.64 ±15.47 years. Seventy-six per cent of women were multiparous. Fifteen patients were obese. The revealing symptoms were dominated by endocrine signs (52.7%). More than half of our patients complained of headache. Sixty-one of the patients had partial empty sella and the remaining 39% had total empty sella. Two or more pituitary hormone deficiency were found in 41% of cases. Secondary adrenal insufficiency was the most common pituitary hormone deficiency(41.7%).The percentage of hypopituitarism in complete primary empty sella was significantly higher than that in partial primary empty sella (P<0.05).The management was based on hormone replacement therapy in case of hypopituitarism and on analgesic therapy in case of headache. Conclusion The diagnosis of PES must be evoked in an obese, multiparous, hypertensive woman presenting with a symptomatology suggestive of a pituitary deficiency or chronic headache. The correlation between pituitary gland volume and the degree of hypopituitarism highlights the importance of the early diagnosis and hormones replacement.


2005 ◽  
Vol 58 (7-8) ◽  
pp. 410-413 ◽  
Author(s):  
Maja Milosevic ◽  
Milos Stojanovic ◽  
Milica Nesovic

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.


2014 ◽  
Vol 29 (2) ◽  
pp. 151
Author(s):  
Soo Kyoung Kim ◽  
Sung Su Kim ◽  
Bo Ra Kim ◽  
Jung Hwa Jung ◽  
Jae Hoon Jung ◽  
...  

Author(s):  
Piyush Lodha ◽  
Srinivas Rao P ◽  
Vijay Sheker Reddy Danda ◽  
Gollapudi Prakash Rao

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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