Incidental empty sella9/25/2023 ![]() ![]() Electrocardiogram was suggestive of left ventricle hypertrophy. Chest X-ray, non-contrast computed tomography head, and abdominal ultrasound were normal. Laboratory investigations showed serum creatinine 0.76 mg/dL, serum potassium 3.81 mmol/L, serum sodium 109.75 mmol/L, urinary sodium 86.57 mmol/L, serum osmolality 236.81 mOsmol/kg, and urine osmolality 246.16 mOsmol/kg. Neurological examination revealed power of 4/5 in all four limbs with normal deep tendon jerks and flexor plantar response. Jugular venous pressure was normal indicating normal extracellular volume. She was afebrile and mildly dehydrated with oxygen saturation of 98% on room air. On examination, she was irritable but obeying verbal commands, pulse rate was 80/min and blood pressure 160/80 mm Hg. Her both deliveries and postpartum periods were uneventful. She had achieved menopause at age of 47 years and had two children. There was no history of use of diuretics or any pituitary surgery or irradiation. Her history showed chronic hyponatremia and similar symptoms that improved with intake of sodium-rich diet and administration of normal saline. There was no history of any cardiac illness. The weakness was generalized, with no involvement of bladder or bowel functions. CASE REPORTĪ 70-year-old woman, known case of hypertension (taking Telmisartan) and chronic obstructive pulmonary disease (using metered dose inhaler of Ipratropium and Levosalbutamol), presented to the emergency department with weakness and difficulty in speaking for 4 days along with one episode of vomiting and seizure and altered sensorium with irritability since then. Adrenal insufficiency is associated with elevated ADH levels resulting in hyponatremia. Adrenal insufficiency can impair water excretion resulting in euvolemic hyponatremia by antidiuretic hormone (ADH) dependent and ADH independent mechanisms. Įmpty sella leads to secondary adrenal insufficiency. Primary empty sella syndrome is seen commonly in obese and multiparous females and occurs due to combination of increased cerebrospinal fluid pressure with defect in diaphragm sellae. While in total empty sella syndrome, pituitary gland thickness is <2 mm and more than 50% of the sella is filled with cerebrospinal fluid. In partial empty sella syndrome, pituitary gland thickness ranges from 3 mm to 7 mm and <50% of the sella is filled with cerebrospinal fluid. Endocrine dysfunction is seen in 25–30% of cases. It has certain distinct anatomical and radiological characteristics. In the absence of any history of irradiation, hemorrhage, and surgery, a diagnosis of primary empty sella syndrome was made.Įmpty sella syndrome may be complete or partial depending on whether the sella turcica is completely or partially filled with cerebrospinal fluid. Her serum sodium levels improved after starting glucocoticoids and thyroxine tablets, thereby confirming the diagnosis of panhypopituitarism. On further evaluation, she was found to have decreased cortisol, decreased follicle stimulating hormone, decreased thyroxine, normal prolactin, and thyroid-stimulating hormone values suggestive of panhypopituitarism. Blood investigations revealed hyponatremia that was euvolemic. This is a case report of a 70-year-old female who presented with complaints of vomiting, altered sensorium with irritability, generalized weakness, difficulty in speaking, and one episode of seizure. Most of the patients are asymptomatic but features of panhypopituitarism can develop in some. It may be partial or complete and can be primary or secondary due to intracranial hypertension, radiation exposure or pituitary apoplexy. Empty sella is often an incidental magnetic resonance imaging (MRI) finding. ![]()
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