Empty Sella Syndrome in a Postmenopausal Woman

A 50-year-old, prematurely postmenopausal diabetic woman was admitted in the Endocrinology department of BIRDEM with the complaints of vomiting, loose motion, lethargy, profound weakness. Previously she suffered from several episodes of electrolyte imbalance and after investigations adrenal insufficiency was diagnosed on 2010. No evaluation was done for her premature menopause. During this episode of illness, she was found with postural hypotension, hyponatremia, dyslipidemia and panhypopituitarism. MRI of sella and parasellar region was done which revealed features suggestive of empty sella. This case gives insight that early menopause warrants proper evaluation and during evaluation, along with other factors hypopituitarism should be considered as an etiology for this condition. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12362 Birdem Med J 2012; 2(1) 52-55

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Adrenal Insufficiency due to Total Primary Empty Sella Syndrome

Journal of Endocrinology and Metabolism ◽

10.14740/jem686 ◽

2020 ◽

Vol 10 (5) ◽

pp. 144-153

Author(s):

Daisuke Usuda ◽

Susumu Takagi ◽

Kohei Takanaga ◽

Toshihide Izumida ◽

Ryusho Sangen ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Empty Sella ◽

Empty Sella Syndrome ◽

Primary Empty Sella

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Hypopituitarism

10.1093/med/9780190678333.003.0041 ◽

2018 ◽

Author(s):

Matthew D. Sjoblom ◽

Diane Gordon ◽

Lori A. Aronson

Keyword(s):

Adrenal Insufficiency ◽

Perioperative Management ◽

Clinical Symptoms ◽

Fluid Management ◽

Pituitary Hormones ◽

Empty Sella ◽

Empty Sella Syndrome ◽

Common Causes ◽

Stress Dose

Hypopituitarism is a decreased secretion of pituitary hormones. It is especially concerning during surgery and anesthesia if it results in adrenal insufficiency, hypothyroidism, or diabetes insipidus. Common causes in children include pituitary tumor and/or treatment, traumatic brain injury, and empty sella syndrome. Perioperative management includes recognition of clinical symptoms, such as hypotension, fatigue, polydipsia, and increased urine output. Unrecognized adrenal insufficiency may result in significant morbidity or mortality. Intraoperative treatment may involve stress-dose corticosteroids, careful fluid management, and desmopressin. This chapter uses the case study of a 9-year-old boy who presents for bilateral removal of tibial orthopedic hardware to illustrate the concepts.

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An Unusual Case of Acute Adrenal Insufficiency

Bangladesh Critical Care Journal ◽

10.3329/bccj.v1i2.17206 ◽

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

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Partial empty sella syndrome, GH deficiency and transient central adrenal insufficiency in a patient with NF1

Endocrine ◽

10.1007/s12020-020-02351-z ◽

2020 ◽

Vol 69 (2) ◽

pp. 377-385

Author(s):

Eleni Magdalini Kyritsi ◽

Maria Hasiotou ◽

Christina Kanaka-Gantenbein

Keyword(s):

Adrenal Insufficiency ◽

Gh Deficiency ◽

Empty Sella ◽

Empty Sella Syndrome ◽

Central Adrenal Insufficiency

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A rare case of hypopituitarism with psychosis

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-13-0007 ◽

2013 ◽

Vol 2013 ◽

Cited By ~ 1

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.

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