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Reversible hypothyroidism in empty sella syndrome: a case report
F Otsuka1, T Ogura, N Hayakawa
1Department of Medicine III, Okayama University Medical School, Japan.
Endocrine Journal
|October 28, 1998
Summary
Physiologic glucocorticoid doses are vital for patients with empty sella syndrome and hypopituitarism. Treatment improved thyroid function and remaining pituitary functions, highlighting the necessity of hormone replacement therapy.
Area of Science:
- Endocrinology
- Reproductive Medicine
- Neuroendocrinology
Background:
- Empty sella syndrome (ESS) is a condition where the pituitary gland appears flattened or empty within the sella turcica.
- ESS can be associated with various degrees of hypopituitarism, affecting multiple pituitary hormone axes.
- Postpartum pituitary apoplexy, though rare, can lead to ESS and subsequent hormonal deficiencies.
Observation:
- A 33-year-old woman presented with fatigue, recurrent infections, and weight loss one year postpartum.
- Endocrinologic evaluation revealed severe adrenal insufficiency and hypothyroidism, with impaired ACTH, PRL, and gonadotropin responses.
- Cranial MRI demonstrated an empty sella, and autoantibodies against the pituitary and thyroid were detected.
Findings:
- The patient was diagnosed with partial hypopituitarism secondary to empty sella syndrome.
- Administration of a physiologic dose of cortisone acetate (25 mg/day) led to significant clinical improvement.
- Thyroid function normalized, and gonadotropin responses to GnRH improved following glucocorticoid replacement.
Implications:
- This case underscores the critical role of glucocorticoids in maintaining not only adrenal function but also other residual pituitary functions in ESS.
- Physiologic glucocorticoid replacement is essential for managing hypopituitarism associated with empty sella syndrome.
- Early diagnosis and appropriate hormone replacement therapy are crucial for improving the quality of life in patients with ESS-related hypopituitarism.