A post menopausal female with empty sella syndrome

R Vithiya,T Kumanan,G Selvaratnam,N Suganthan

doi:10.4038/jmj.v28i2.52

Abstract

Empty sella syndrome is an incidental anatomical finding which can occasionally present as hypopituitarism. Here we report a post-menopausal female with emptysella syndrome and anterior pituitary hormone deficiency. She is a 69 year-old mother of four children presented with progressively worsening lethargy and constipation. Her last pregnancy at 24 years was complicated with post-partum haemorrhage. She had breastfed her last child for an year. She attained menopause at the age of 45. Investigations revealed normocytic anemia, and hyponatremia. Hormonal profile showed a normal TSH level(2.09mu/l)and low free T4 (<0.07 ng/dl) suggestive of secondary hypothyroidism. She also had low level of 9am cortisol, and inappropriately low FSH and LH levels. Non-contrast computerized tomography of the brain revealed cerebrospinal fluid(CSF) within sella-turcica, suggestive of empty-sella syndrome. She was treated with replacement doses of hydrocortisone and thyroxine and with that her symptoms improved.

Highlights

Empty sella syndrome is a rare clinical condition in which the sella turcica or pituitary fossa is filled with cerebrospinal fluid resulting in compression of pituitary gland
We present a case of empty-sella syndrome and hypopituitarism in a post menopausal female
Gender support the diagnosis of primary empty sellar syndrome. She had a history of post partum hemorrhage, establishment of breast feeding, and regular menstruation until age of 45 years makes the diagnosis of Sheehan syndrome less likely as the cause for hypopituitarism or secondary empty sella syndrome

Summary

Empty sella syndrome is an incidental anatomical finding which can occasionally present as hypopituitarism. We report a post-menopausal female with emptysella syndrome and anterior pituitary hormone deficiency. She is a 69 year-old mother of four children presented with progressively worsening lethargy and constipation. Her last pregnancy at 24 years was complicated with post-partum haemorrhage. Hormonal profile showed a normal TSH level(2.09mu/l)and low free T4 (

Background

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