Empty Sella Syndrome with Profound Hypopituitarism

Abstract

Empty sella (ES) is characterized by herniation of subarachnoid space within the sella caused by various etiopathogenetic mechanisms. Although ES can be presented as benign and asymptomatic condition, it can be also associated with pituitary dysfunction, opthalmologic and neurological abnormalities. Case report: We describe a case of empty sella with profound hypopituitarism. A 36-year-old man was refered to our hospital for evaluation of his obesity. He had complaints of decreased libido, anejaculation, depressive mood and lack of energy for several years. On examination he had body mass index 34kg/m2, waist circumference 108 cm and normal blood pressure. His medical history was unremarkable except for previous head injury. The hormone analysis showed TSH l 9.95 uIU/ml (0.4-4.0), free T4 0.64ng/dl (0.90-1.80), free T3 2.14 pg/ml (1.80-4.20), LH 0.710 mIU/ml(0.80-7.60), FSH 3,25mIU/ml (0.70-11.1), GH 0.05ng/ml (<5ng/ml), prolactin 25ng/ml (2-29) cortisol 3.45ug/dl (5-25) and ACTH 14.3pg/ml (5-48). Other laboratory investigation were significant for hyperinsulinemia, 41 uIU/ml (2-29.1) and atherogenic lipid profile. Furthermore the patient had severe vitamin D deficiency 18.6 nmol/L (75-250). Magnetic resonance imaging of hypotalamic-pituitary area revealed invagination of subarachnoid space to sella, narrow glandular tissue on the left side and pituitary microadneoma of 6 mm within it. Ophtalmological and visual filed examination were insignificant. Replacement hormonal therapy was initiated and patient clinically improved. Conclusion: in our patient ES might be a consequence of previous brain injury. ES syndrome is characterized by variable clinical manifestations. Therefore, patients with ES should be subjected to endocrinological, neurological and ophthalmological evaluation.