May primary empty sella turcica be a cause of isolated ACTH deficiency? A case report and the review of related literature.
Isolated ACTH deficiency is an uncommon cause of secondary adrenocortical insufficiency and accompaniment with primary empty sella has been reported in several cases. We present a case of isolated ACTH deficiency associated with empty sella. A sixty-two year old woman was admitted to our endocrine clinic with complaints of weakness, fatigue, weight loss, nausea, vomiting, and lack of appetite for about one month. Physical examination indicated orthostatic hypotension and epigastric tenderness. Laboratory investigations revealed hypoglycemia, hyponatremia and anemia, in addition low plasma cortisole and ACTH levels. Serum cortisole responses to short and prolonged ACTH stimulation were tested and partial and accurate responses were obtained, respectively. Plasma ACTH and serum cortisole levels failed to respond after intravenous injection of human corticotropin releasing hormone. Other hypophysial hormone levels were within the normal reference ranges. Although cranial and abdominal computerized tomography images were evaluated as normal, cranial magnetic resonance imaging of the pituitary gland revealed 'primary empty sella turcica'. Replacement therapy with methylprednisolon resulted in the improvement of hypoglycemia, hyponatremia and clinical symptoms. Based on these results, the patient was diagnosed as isolated ACTH deficiency and was scheduled for follow up by our outpatient clinic. Our report is consistent with other reports pointing out that primary empty sella may be responsible for pathogenesis of isolated ACTH deficiency.
Dumlupinar University Hospital, Department Of Internal Medicine, Anatomy, Cardiology, Merkez Kampus, Kutahya, Turkey. drerimgulcan@gmail.com
Erim
E
Gulcan
Aynur
A
Gulcan
Figen
F
Taser
Ugur
U
Korkmaz
Enver
E
Erbilen
D000309:Adrenal Insufficiency / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000172:deficiency*; D004652:Empty Sella Syndrome / Q000097:blood / Q000150:complications*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010901:Pituitary Function Tests; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D008775:Methylprednisolone