Isolated Menarche and Empty Sella Turca: A Rare Pediatric Case

Isolated menarche is a rare condition characterized by vaginal bleeding without other pubertal signs. Primary empty sella is usually an incidental finding but may be associated with pituitary dysfunction. We report a 10-year-old girl evaluated for short stature and two episodes of vaginal bleeding. She showed a prepubertal stage, delayed bone age, and a prepubertal uterus and ovaries on ultrasound. Magnetic resonance imaging revealed a primary empty sella. Progressive growth failure and an inadequate response to a stimulation test led to the initiation of growth hormone therapy at 13 years. At 14 years, she developed symptoms of adrenal insufficiency supported by a low morning cortisol value, requiring hydrocortisone treatment. Puberty progressed spontaneously, and menarche occurred at 15 years. At 17 years, she continues treatment with improved growth and resolution of symptoms.