Case Of Empty Sella Syndrome Research Articles

SAT-466 Cases of Acromegaly and Presumed Prolactinoma in Setting of Empty Sella Syndrome: Presentation and Management Implications

Introduction; Empty Sella syndrome (ESS) is an uncommon finding on brain imaging whose functional significance remains controversial. While sometimes associated with pituitary hypofunction it is far less commonly associated with pituitary hyperfunction syndromes. We present two cases of this; one with acromegaly and one of hyperprolactinemia presumably due to prolactinoma both associated with ESS on brain imaging. Clinical Cases; A 48 yr old man was evaluated on account of reduced libido and chronic fatigue which revealed hypogonadotrophic hypogonadism. Further work up revealed prolactin levels in the 250-300ng/ml range. Brain MRI showed ESS and the rest of the pituitary hormone functional work up was normal. Bone density showed osteopenia and octreotide scan showed no sella enhancement nor other anomalies. When commenced on cabergoline 0.5mg 2 x wkly his prolactin levels normalized over 6 months and the hypogonadism resolved without requiring androgen replacement. A 49 yr old gentleman with long standing hypogonadotrophic hypogonadism on androgen replacement presented with persistent headaches and generalized arthralgias. He had clinical features suggestive of acromegaly including macrocephaly, macroglossia, facial dysmorphia and enlarged hands and feet. Diagnosis was confirmed by elevated IGF-1 (300-400ng/ml range), growth hormone levels and non suppressible growth hormone on Oral glucose tolerance test. No other pituitary functional deficits were found. Brain MRI showed ESS and octreotide scan showed no sella enhancement nor other anomalies. His IGF-1 levels normalized with octreotide LAR 20mg monthly. His androgen repletion also improved with lower testosterone dose requirement along with improvement in headaches and arthralgias though he developed type 2 diabetes. Results and Discussion; Review of our system's clinical records over the prior 5 years revealed 307 cases of ESS. 10 had hypopituitarism, 6 had hypogonadism, 12 had hyperprolactinemia presumed due to prolactinoma, 1 each had central hypothyroidism, acromegaly and diabetes insipidus. 276 (92%) of cases had normal pituitary functional status. Concluding remarks; ESS is an uncommon but important imaging finding on brain imaging. Though most patients with ESS have normal pituitary function it may be associated with pituitary hypofunction or even hyperfunction states. Its finding in pituitary hyperfunction states like hyperprolactinemia and acromegaly make medication therapy the only viable treatment option as surgery and radiotherapy have no visible target to direct therapy.

Primary empty sella syndrome in a woman with metabolic syndrome presenting with syncopal attack: A case report

Background: Empty sella syndrome (ESS) is a disorder that is characterised by leakage of cerebrospinal fluid (CSF) in the sella turcica through a diaphragmatic sellae defect, leading to compression and flattening of the pituitary gland. It is usually asymptomatic and mostly incidentally detected during neuroimaging for other conditions. There is no data reporting a case of primary ESS in a woman with metabolic syndromepresenting with syncopal attack.Case report: A 62-year old, postmenopausal woman with metabolic syndrome, presented to our Endocrine clinic with the history of recurrent syncopal attack for the past 13 years and associated early morning headache and later diagnosed with primary empty sella syndrome.Conclusion: Primary empty sella syndrome should be keenly investigated for with high index of suspicion in women with metabolic syndrome presenting with syncopal attack and headache.Key words: Primary empty sella syndrome, Metabolic syndrome, Syncopal attack, Headache

A Case with Empty Sella Syndrome Combined with Multiple Anterior Pituitary Hormone Deficiencies Presenting as Hypoglycemic Coma

<title>Abstract A 55-year-old male was admitted to emergency department with a hypoglycemic shock of unknown origin. He was presented with tonic seizure activity after admission. Initial diagnostic procedure could exclude diabetes mellitus, drug side effects, and exogenous insulin application. Detailed evaluation of the patient's history revealed that the patient had experienced repeated hypoglycemic episodes for 2 years. He was diagnosed with hypothyroidism six years ago. Initial laboratory investigations revealed hypoglycemia, hyponatremia, and low plasma cortisol level (0.18 pg/dᄂ)· Sellar magnetic resonance imaging showed empty sella. Replacement therapy with hydrocortisone resulted in the improvement of clinical symptoms. Combined pituitary stimulation test with exception of hypoglycemia induced growth hormone and cortisol stimulation test was performed. The response of thyroid stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone was normal. We report the case of empty sella syndrome associated with hypoglycemic shock due to with multiple anterior pituitary hormone deficiencies.</p>

消化器症状を伴つたEmpty sella syndromeの1例

消化器症状を伴つたEmpty sella syndromeの1例

Sellar Reconstruction: Is it Necessary?

Sellar reconstruction is practiced routinely during the transsphenoidal approach to pituitary tumor resection. This practice exposes the patient to risks of donor site complications and may interfere with measuring postoperative tumor reduction. We propose that it is not a necessary component of transsphenoidal pituitary surgery in the absence of intraoperative cerebrospinal fluid (CSF) leak. A retrospective chart review of 45 cases of minimally invasive pituitary surgery were reviewed. Twenty-eight cases were identified with no sellar reconstruction being performed. Age, sex, revision surgery, postoperative CSF leak, days with lumbar drain, meningitis, ophthalmoplegia, visual acuity loss, postoperative epistaxis, diabetes insipidus, development of empty sella syndrome, and length of stay were investigated in these cases. Twenty-three cases were the primary procedure and five cases were revision surgery. Complication rates were low and compared favorably with those reported in the literature. Five cases of transient diabetes insipidus occurred. There was one postoperative CSF leak that required 4 days with a lumbar drain. No cases of empty sella syndrome developed. There were no cases of meningitis. The average length of stay was 2.9 days. Sellar reconstruction during transsphenoidal approach to pituitary tumor resection is not required for patients without evidence of an intraoperative CSF leak. This practice exposes the patient to the risks of donor site complications without reducing the rate of postoperative complications.

A case of empty sella syndrome presenting dissociation between pituitary hormone basic value and target hormone value.

症例は61歳,女性. 25年前に下垂体卒中の既往があり,全身倦怠,食欲不振を主訴に入院.画像診断ではトルコ鞍のballooningを伴うempty sellaを認め, ACTH, TSH, GHの基礎値は正常範囲にも拘わらず,標的ホルモンであるコルチゾール, FT4,ソマトメジンCは低値を示した.各種負荷試験で下垂体ホルモンの反応性の低下,夜間連続採血では下垂体ホルモンの律動分泌の消失が確認された.これらが下垂体ホルモン基礎値と標的ホルモン値に解離のみられた原因と考えられた.

Abnormal sella turcica. A tumor board review of the clinical significance

Sixty of 146 patients with intracranial neoplasms or arterial aneurysms had roentgenographic abnormalities of the sella turcica. These abnormalities were most commonly due to chromophobe adenoma, craniopharygioma, and acromegaly, but ten of them were caused by lesions arising distant to the sella. There were also three cases of empty sella syndrome. Headache, visual disturbance, and sexual dysfunction were the most frequent presenting complaints, with visual field abnormality being most common. Pituitary dysfunction was manifested most frequently by alterations in growth hormone level and gonadotrophin secretion and less frequently by hypothyroidism and adrenocortical insufficiency. When the abnormal sella was associated with evidence of symptomatic intracranial disease, endocrine dysfunction, or visual field compromise as evidence of an anatomically aggressive intracranial neoplasm, specialized neuroroentgenographic localizing procedures were usually positive, and treatment for most of the causative lesions was highly effective.

Dynamic roentgenographic changes in the empty sella syndrome.

Two cases of empty sella syndrome are presented. Progressive sellar enlargement was documented together with evidence of increased intracranial pressure. One patient exhibited de novo development of an empty sella turcica.

The empty sella and some related syndromes.

✓ A case of empty sella syndrome due to a benign intrasellar cyst leads the author to a review of variations in this syndrome. Association with intrasellar diverticuli of the subarachnoid space, deficiencies of the diaphragma sellae, and small pituitary glands are identified. Its relationship with certain headaches in women and to unexplained nontraumatic cerebrospinal fluid rhinorrhea are discussed.

Primary Empty Sella Syndrome: A Case Report

Primary Empty Sella Syndrome (PES) is a relatively rare or uncommon developmental disease that develops spontaneously. It is characterized by herniation of subarachnoid space within the sella which is often associated with some degree of flattening of pituitary gland. Usually manifested by endocrine abnormalities, ocular abnormalities, rhinitis and intractable persistent headache. It is higher in obese females having multiple pregnancies. Here we report a case of empty sella syndrome in a 27 year old lady to aware the physicians to bear in mind a differential in patients having persistent intractable headache. Key words: Empty Sella Syndrome; Woman; Obesity; Intractable Headache DOI: 10.3329/akmmcj.v1i1.7456 Anwer Khan Modern Medical College Journal 2010; 1(1): 23-25