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Case Report
Empty sella and reversible central adrenal insufficiency in treated primary hypothyroidism
1 Department of Medicine, Unit of Endocrinology and Diabetology, Mubarak Al-Kabeer Hospital, Al-Jaberiyah, Hawalli Governorate, Kuwait
2 Faculty of Medicine, Department of Radiology, Kuwait University, Al-Jaberiyah, Hawalli Governorate, Kuwait
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Marwa MS Al-Qudheeby
MD, KBIM, FRCP(UK), SF-Endo; Department of Medicine, Unit of Endocrinology and Diabetology, Mubarak Al-Kabeer Hospital, Alsalam, Block 2, Street 221, House 80, Al-Jaberiyah, Hawalli Governorate,
Kuwait
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Article ID: 101479Z01MA2024
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Al-Qudheeby MMS, Al-Tarrah HA, Al-Azmi F, Mehraj S. Empty sella and reversible central adrenal insufficiency in treated primary hypothyroidism. Int J Case Rep Images 2024;15(2):96–102.ABSTRACT
Introduction: Primary hypothyroidism can be complicated by pituitary-related sequelae. Along with a few other reports, we documented pituitary dysfunction with empty sella in primary hypothyroidism; however, the spontaneous reversibility of the hypopituitarism is rarely reported. We aimed to describe a rare complication of primary hypothyroidism and to emphasize the importance of monitoring such complications.
Case Report: We report a previously healthy 59-year-old man who presented four years earlier with weight gain of several months duration. The investigations revealed primary hypothyroidism with thyroxine 5.2 pmol/L (7.8–16) and thyroid stimulating hormone >100 uIU/L (0.27–4.2). He responded well to the thyroxine replacement as he became asymptomatic with normalization of thyroid stimulating hormone (TSH). After a few years, the patient presented with lethargy and postural hypotension despite euthyroidism. The basal and stimulated cortisol levels were low 73 (185–624) and 185 nmol/L respectively, while the adrenocorticotrophic hormone was inappropriately normal at 16.1 pg/mL (10.00–46.00). All the other pituitary hormones were normal. Magnetic resonance imaging showed partial empty sella. The patient preferred conservative management. Subsequently, he showed progressive clinical and hormonal improvement. As scarcely reported in the literature, primary hypothyroidism can be complicated by the development of empty sella, which can further develop pituitary endocrinopathies. Central adrenal insufficiency has been reported more often than other empty sella-related pituitary endocrinopathies, which might need long-term therapy.
Conclusion: We documented that empty sella and the associated hypopituitarism might complicate the primary hypothyroidism. This report encourages monitoring, and managing these complications in longer-term follow-up.
Keywords: Adrenal insufficiency, Empty sella syndrome, Hypothyroidism, Primary
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Author Contributions
Marwa MS Al-Qudheeby - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Hasan Ali Al-Tarrah - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Fayez Al Azmi - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Shaikh Mehraj - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Marwa MS Al-Qudheeby et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
