Endocrine Abstracts (2011) 26 P641

Multiple pituitary deficiencies in a young patient with primary empty sella

A Rusu, C Cristea, L Gheorghiu, R Balcan & V Mogos

UMF Gr. T. Popa, Iasi, Romania.

Introduction: Usually, the hormonal profile is normal in patients with empty sella. However, when present, hormonal deficiency most commonly consist in growth disturbance in children and mild hyperprolactinaemia in adults. Hypopititarism with signs of symptomatic dysfunction occurs in <10% of patient with primary empty sella.

Case report: A 27-years-old man presented to our department in 2008 with impuberism, micropenis, hypoplasic scrotum, inguinal gonads. He presented an eunucoid habitus but the karyotype was 46xy and the Barr test was negative. Laboratory tests showed prepubertal levels of FSH,LH and testosterone. The IGF1 level was also normal. The MRI revealed an empty sella. He started treatment with testosterone-gel which was stopped 2 months later due to upper arms acne. In 2010, without any treatment, the evaluation reconfirmed the hypogonadotropic hypogonadism (LH=1.2 mUI/ml, FSH=0.7 mUI/ml, testosterone=0.9 ng/ml). PRL level was slightly elevated (15.8 pg/ml, n<15). But further tests showed thyreotrop and corticoptrop deficiency (FT4=7.44 pmol/l, n=12–22 pmol/l and cortisol=9.4 ng/ml, n=60–230).Clinically, the patient didn’t show symptoms of adrenal or thyroid hypofunction. The MRI revealed empty sella with compression of the pituitary gland. He received treatment with testosterone enanthate, prednisone and levothyroxinum.

Conclusion: Considering the possibility for the development in time of global pituitary hypofunction, when empty sella is confirmed, the early diagnosis of the deficits leads to proper replacement therapy avoiding potential life-threatening situations for the patient.

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