Kosin Med J.  2014 Dec;29(2):151-155. 10.7180/kmj.2014.29.2.151.

A Case with Empty Sella Syndrome Combined with Multiple Anterior Pituitary Hormone Deficiencies Presenting as Hypoglycemic Coma

• Kim SK
• Kim SS
• Kim BR
• Jung JH
• Jung JH
• Hahm JR

• KMID: 2308501
• DOI: http://doi.org/10.7180/kmj.2014.29.2.151

Abstract

A 55-year-old male was admitted to emergency department with a hypoglycemic shock of unknown origin. He was presented with tonic seizure activity after admission. Initial diagnostic procedure could exclude diabetes mellitus, drug side effects, and exogenous insulin application. Detailed evaluation of the patient's history revealed that the patient had experienced repeated hypoglycemic episodes for 2 years. He was diagnosed with hypothyroidism six years ago. Initial laboratory investigations revealed hypoglycemia, hyponatremia, and low plasma cortisol level (0.18 microg/dL). Sellar magnetic resonance imaging showed empty sella. Replacement therapy with hydrocortisone resulted in the improvement of clinical symptoms. Combined pituitary stimulation test with exception of hypoglycemia induced growth hormone and cortisol stimulation test was performed. The response of thyroid stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone was normal. We report the case of empty sella syndrome associated with hypoglycemic shock due to with multiple anterior pituitary hormone deficiencies.

Keyword

ACTH deficiency; Empty sella; Hypoglycemia

MeSH Terms

Coma*
Diabetes Mellitus
Emergency Service, Hospital
Empty Sella Syndrome*
Follicle Stimulating Hormone
Growth Hormone
Humans
Hydrocortisone
Hypoglycemia
Hyponatremia
Hypothyroidism
Insulin
Luteinizing Hormone
Magnetic Resonance Imaging
Male
Middle Aged
Plasma
Prolactin
Seizures
Shock
Thyrotropin
Follicle Stimulating Hormone
Growth Hormone
Hydrocortisone
Insulin
Luteinizing Hormone
Prolactin
Thyrotropin

Figure

• 

  Fig-1: The lateral sk䴸ᅵ x-ray is shown that the sella t䴸rcica appears to be mildly enlarged (Fig. 1A). Tl-weighted image (sagittal image) showed an empty sella and T2-weighted image (coronary image) showed hyper-intense signal intensity (Fig. 1B), s䴸ggesting an empty sella.

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