ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 49 EP842 | DOI: 10.1530/endoabs.49.EP842

A hypopituitarism case diagnosed after sphenoid sinus mucocele operation

Betül Ekiz-Bilir1, Bülent Bilir2, Aysel Öz3, Halide Günes-Ciftci4, Neslihan Soysal-Atile1 & Gülsah Elbüken5

1Endocrinology and Metabolic Diseases Division, Tekirdag State Hospital, Tekirdag, Turkey; 2Internal Medicine Department, Medical Faulty, Namik Kemal University, Tekirdag, Turkey; 3Radiology Department, Tekirdag State Hospital, Tekirdag, Turkey; 4Department of Otolaryngology and Head and Neck Surgery, Tekirdag State Hospital, Tekirdag, Turkey; 5Internal Medicine Department, Endocrinology and Metabolic Diseases Division, Medical Faculty, Namik Kemal University, Tekirdag, Turkey.

Introduction: Mucoceles-mucus containing benign cysts of paranasal sinuses- are common with an incidence of 1% but involvement of sphenoid sinus is much less common. In this case report, we reported a patient presented with hypopituitarism after sphenoid mucocele drainage operation.

Case report: A 59- year-old woman was admitted to our endocrinology out-patient clinics with a complaint of fatigue over the past 2 months. One month prior to admission, she had been internalized for about 10 days in our hospital’s infectious diseases clinics for fever of unknown origin. After extensive medical investigation, a sphenoid sinus mucocele and pansinusitis had been diagnosed. An operation for drainage of the mucocele with endonasal surgical approach had been performed and she had been externalized for follow-up with an attention card indicating that her nasal cavity was in direct contiguity with the optic nerve. Three weeks after the operation, she admitted to our clinics. The physical examination revealed that her arterial blood pressure was 90/50 mmHg, heart rate was 108 bpm, respiratory, abdominal, cardiac examinations were normal. Her skin was pale and minimal pitting edema was detected. In her repeated laboratory examination, serum cortisol levels were found to be less than 1 μg/dl. Coexisting secondary hypothyroidism and GH deficiency were detected. The magnetic resonance imaging of the pituitary region was revealed no tissue corresponding to the adenohypophysis. Following adequate replacement therapy with methyl-prednisolone and levo-thyroxine, her fatigue relieved. GH replacement therapy was refused by the patient for its administration difficulty.

Conclusion: For mucoceles involving sphenoid sinus, pre-operative and post-operative endocrinological evaluation is essential.

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