Severe Hyponatremia due to Hypopituitarism Secondary to Empty Sella Syndrome
This case is about a 68 years old patient presented with worsening generalized weakness, dizziness, low mood and reduced appetite with the background history of gout and vitamin D deficiency. On general examination, the patient appeared very lethargic. However, the systemic examination was unremarkable. The vitals check showed a low blood pressure of 104/72 mm Hg. The investigations showed low levels of serum Sodium, Thyroid stimulating hormone, Cortisol. The short Synacthen test was abnormal. The anterior pituitary hormones level showed low levels of Follicle stimulating hormone, Luteinizing hormone and prolactin. CT head with contrast showed enlarged fluid filled pituitary fossa with fat. An MRI Pituitary gland showed an empty sella syndrome. The patient was hydrated initially and electrolytes were monitored regularly. Treated with hydrocortisone and thyroxine to which the patient responded and improved significantly. A follow-up appointment was arranged at endocrine clinic
2. Maira G, Anile C, Mangiola A. Primary empty sella syndrome in a series of 142 patients. J Neurosurg.2005;103:831–836.[PubMed][Google Scholar]
3. Kim JH, Ko JH, Kim HW, Ha HG, Jung CK. Analysis of empty sella secondary to the brain tumors. J Korean Neurosurg Soc. 2009;46:355–359.[PMC free article] [PubMed] [Google Scholar]
4. Jdrdan RM, Kendall JW, Kerber CW. The primary empty sella syndrome. Analysis of the clinical characteristics, radiographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone concentrations. Am J Med 1977; 62:569.
5. Melmed S, Kleinberg D, Ho Ken. Pitutary physiology and diagnostic evaluation. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, editors. Williams textbook of endocrinology, Chap 8. 12. Philadelphia: Elsevier; 2011. [Google Scholar]
6. Hossain MS, Mumu MA, Moyenuddin PK. Primary empty sella syndrome: A case report. AKMMC J 2010; 1(1):23-25.
7. Aijazi I, Abdullah Al Shama FM, Adam Mukhtar SH. Primary Empty Sella Syndrome Presenting With Severe Hyponatremia And Minimal Salt Wasting. J Ayub Med Coll Abbottabad. 2016;28:605–608. [PubMed] [Google Scholar
8 . Xu P, He H, Chen Y, Wang C, Zhu Y, Ye X. Osteoporotic fractures and persistent non-fusion of the hand epiphyses caused by empty sella syndrome in an adult: a case report. J Int Med Res. 2013;41:1768–1772. [PubMed] [Google Scholar]
9. Dange N, Redhu R, Kawale J, Mahore A. Primary amenorrhea due to empty sella: an underestimated entity. Turk Neurosurg. 2012;22:499–501. [PubMed] [Google Scholar]
10. Yamamoto T, Fukuyama J, Kabayama Y, Harada H. Dual facets of hyponatraemia and arginine vasopressin in patients with ACTH deficiency. Clin Endocrinol (Oxf) 1998;49(6):785–92
11.Yonemura K, Furuya R, Oki Y, Matsushima H, Ohishi K, Hishida A. Impaired water excretion in a hyponatremic patient following thyroidectomy: causal role of glucocorticoid deficiency. Miner Electrolyte Metab 1998;24(5):341–7.
12. Erkut ZA, Pool C, Swaab DF. Glucocorticoids Suppress Corticotropin-Releasing Hormone and Vasopressin Expression in Human Hypothalamic Neurons1. J Clin Endocrinol Metabol 1998;83(6):2066–73.
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