SAT346 Empty Sella Syndrome And Hypopituitarism In A Childhood Cancer Survivor

Abstract

Abstract Disclosure: W. Akhter: None. J.L. Gilden: None. Introduction: It has been reported that 50% of childhood cancer survivors develop an endocrinopathy and require life-long monitoring. Hypopituitarism is common in patients who have been treated with radiotherapy and is progressive and irreversible. We present the case of a young cancer survivor, referred for evaluation of secondary amenorrhea and hyperprolactinemia., who was diagnosed with empty sella syndrome and hypopituitarism. Clinical Case: A 29-year-old female with past history of right maxillary rhabdomyosarcoma at age 15, treated with chemotherapy and radiation, was referred to the endocrinology clinic for evaluation of secondary amenorrhea and hyperprolactinemia. Menarche was at age 13, and stopped when starting chemotherapy and radiation. She had not been treated with hormone replacements or dopamine agonists. Upon evaluation, she had fatigue, lethargy, generalized muscle weakness, but denied headaches, fractures, abdominal pain, galactorrhea, and vaginal dryness. Laboratory revealed hypopituitarism with low estradiol <15 (nl=30-400 pg/ml premenopausal women, <10 pg/ml postmenopausal women) with inappropriately low FSH 0.82 (nl=1.5-12.4 mIU/ml), and low LH 0.22 (nl=5-25 IU/L premenopausal female), high prolactin 41.3 (nl=non-pregnant female <25 ng/mL, pregnant female 80-400 ng/mL), negative HCG, low cortisol 3.4 (nl=5-25 mcg/dL), low ACTH 9.7 (nl= 10-60 pg/mL), normal TSH 2.446 (nl=0.27-4.20 uIU/mL) and Free T4 0.54 (nl=0.5-1.6 ng/dL), negative thyroglobulin <1 (nl=0-4 IU/mL) and thyroid peroxidase AB 0.46(n=0-9 IU/mL), normal HbA1C 5.2(nl<5.7 %). MRI pituitary with contrast done 11 yrs. earlier showed a 1.5 mm focus of relative delayed and nonenhancement between anterior and posterior pituitary gland, as well as an overall volume of the pituitary smaller than expected for age. However, recent repeat MRI of brain and sella revealed a partially empty sella without evidence of macro or microadenoma. Conclusion: Patients with childhood malignancies have a greater chance of survival, as observed in the past 30 years. It is now recognized that disorders of the hypothalamic-pituitary axis can occur at any time in patients who have undergone radiation therapy. We should be aware that empty sella syndrome, which can be caused by radiation, can also be associated with hormonal abnormalities. Studies have reported that 50 % of patients with empty sella syndrome had endocrine dysfunction, with the most common endocrine abnormality being hyperprolactinemia. Therefore, amenorrhea in our patient could be from hypopituitarism caused by radiation and empty sella, as opposed to hyperprolactinemia. When evaluating amenorrhea our focus should not be entirely on hyperprolactinemia, but a diagnosis of empty sella syndrome can be missed, thus delaying appropriate hormonal replacement therapy. Presentation: Saturday, June 17, 2023