A 41 year old male presented with erectile dysfunction associated with clinical hypogonadism (testosterone 0.8 nanomoles/litre). Hypopituitarism was confirmed on endocrine testing: Free T3 2.7 picomoles/litre, TSH 1.7 milliunits/litres, LH 0.6 units/litre, FSH 2.3 units/litre, PRL 34 units/litre, GH <0.5 milliunits/litre, IGF-1 10.5 nanomoles/litre, flat response of LH and FSH to Gn-RH, GH <0.5 milliunits/litre throughout ITT. (Cortisol rose from 197 to 523 nanomoles/litre). Magnetic resonance imaging demonstrated that the cause of the hypopituitarism was the empty sella syndrome. He was started on L-thyroxine and his erectile dysfunction improved on treatment with Andropatch.
Further enquiry revealed past neurological events: he had presented in 1981 with an idiopathic sixth nerve palsy (CT scan, carotid angiography normal) and in 1991 with benign intracranial hypertension thought to be secondary to a sagittal sinus thrombosis: he was treated with dexamethasone but it proved necessary to insert a lumbar peritoneal shunt. An association between benign intracranial hypertension and the empty sella syndrome is rare but recognised. A causative mechanism has been proposed. We postulate that this was the causation in our patient.
03 - 04 Dec 2001
Society for Endocrinology