Endocrine Abstracts

A 22-year-old female complaining about irregular menses associated to a slight increase of serum PRL and the recent onset of headache, nausea, dizziness, photophobia, occasional diplopia, visual impairment, anxiety and panic attacks was evaluated for the possible presence of a cerebral mass with intracranial hypertension. Fundoscopic examination and visual field were both normal. There was an empty sella with a flattened pituitary gland along the floor of the pituitary fossa and normal ventricular size at NMR. A lumbar puncture showed an increased CSF opening pressure (250 mmH₂O), with normal composition of CSF. FSH, LH, 17β estradiol, FT₄, FT₃, ACTH and cortisol were normal. PRL and TSH were slightly augmented whereas IGF1 and the GH response to GHRH+arginine were reduced. Clinical conditions slightly improved and the patient was discharged with 12.5 μg of levo-tiroxine. After 3 months, she came back complaining about the progressive worsening of the headache and the onset of cervical pain, with scarce response to analgesics, a further worsening in orthostatic position and transient relief after prolonged bed rest and hydration. At NMR the empty sella was no longer evident as the pituitary gland had reassumed its normal position. The peduncle was dislocated on the right side with no evidence of a pituitary adenoma. Cerebellar tonsils were displaced in the occipital foramen and there was an impregnation of the dura mater and of the meninges of the internal acoustic meatus. The picture was that of a CSF hypotension, probably determined by the previously performed lumbar puncture causing a meningeal leak of CSF, with consequent desappearance of the empty sella. The patient was submitted to epidural blood patch at lumbar level. The clinical as well as the NMR picture gradually improved.