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LETTER TO THE EDITOR
Year : 2014  |  Volume : 11  |  Issue : 3  |  Page : 137-138

Primary empty sella syndrome presenting as isolated central hypothyroidism


1 Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences University, Sawangi, Wardha, Maharashtra, India
2 Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences University, Sawangi, Wardha, Maharashtra, India
3 Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences University, Sawangi, Wardha, Maharashtra, India

Date of Web Publication13-Aug-2014

Correspondence Address:
Sourya Acharya
Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences University, Sawangi (M), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.138565

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How to cite this article:
Acharya S, Shukla S, Kashikar S, Dasarwar S, Mahajan SN. Primary empty sella syndrome presenting as isolated central hypothyroidism. Thyroid Res Pract 2014;11:137-8

How to cite this URL:
Acharya S, Shukla S, Kashikar S, Dasarwar S, Mahajan SN. Primary empty sella syndrome presenting as isolated central hypothyroidism. Thyroid Res Pract [serial online] 2014 [cited 2019 Dec 16];11:137-8. Available from: http://www.thetrp.net/text.asp?2014/11/3/137/138565

Sir,

Central hypothyroidism is frequently seen after pituitary surgery, radiation therapy or head injury. Usually it is associated with deficiency of other pituitary hormones. Seehan's syndrome is a common cause in females. We describe a case of a female who was presented to us with features of frank hypothyroidism and the investigations revealed central hypothyroidism with empty sella syndrome. Isolated TSH deficiency with empty sella syndrome is rare.

A 35-year-old female was presented to us with complaints of excessive fatigability, weakness, puffiness of face since 2 yrs [Figure 1]. There was no history of vomiting, headaches, head trauma, irradiation, urinary complaints, palpitations, dyspnea, bleeding per vaginum, chronic diarrhea, and fever. There was also no history of jaundice. On asking leading question she admitted of hoarseness of voice and chronic constipation. She did not visit any hospital for the same and used to take on and off vitamin supplementation from village doctor. She was married 13 yrs ago, with one healthy child.
Figure 1: Features of hypothyroidism

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On examination her pulse was 52 beats per min (regular, BP-110/60 mmhg). RR was 16/min, JVP was normal, edema feet was present which was non-pitting type. Other systemic examinations were normal. CNS examination showed normal higher functions, normal cranial nerves, and no hemianopia. Deep tendon reflexes (ankle and biceps) showed delayed relaxation. A provisional diagnosis of primary hypothyroidism was made.

On investigation, hemogram was normal. Kidney and liver function tests were normal. Thyroid profile revealed, Serum TSH; <0.05 mU/L (normal, 0.5 to 4.5 mU/L), thyroxine (T 4 ) 4.2 μg/dL (4.5 to 11.5 μg/dL), triiodothyronine (T 3 ) 0.68 ng/mL (0.8 to 2.0 ng/mL), early morning cortisol, FSH, LH, Prolactin levels were normal. MRI of the brain revealed empty sella syndrome [Figure 2].
Figure 2: MRI of Pituitary showing empty sella turcica

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She was started with levothyroxine therapy 100 μg/day, and is awaiting follow up after one month.


  Discussion Top


Central hypothyroidism (CH) is hypothyroidism due to insufficient stimulation by thyroid stimulating hormone (TSH) of an otherwise normal thyroid gland. It can occur at the level of the the pituitary gland (secondary hypothyroidism) or hypothalamus (tertiary hypothyroidism). [1] The prevalence is estimated to be around 1 in 80,000 to 1 in 120,000 individual. [2] It occurs in both the sexes equally. In adults, it is more common due to pituitary macroadenomas, pituitary surgeries or irradiations.

Primary empty sella syndrome is an entity characterized by a sella filled with cerebrospinal fluid and a flattened pituitary gland due to raised pressure in the sella turcica. This syndrome has been reported in 6-20% of unselected autopsies. Secondary empty sella syndrome is induced by surgery or radiation therapy for pituitary adenomas, traumatic injury, infection, and Sheehan syndrome. Our patient had none of the history suggestive of secondary empty sella syndrome. In primary empty sella syndrome, hypopituitarism is present in 10-57% of patients; and growth hormone deficiency is the most frequent pituitary hormone deficiency. Hyperprolactinemia due to distortion of the pituitary stalk is seen in 10-18%, but CH is rarely identified. [3]



 
  References Top

1.Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab 2008;4:683-94.  Back to cited text no. 1
    
2.Samuels MH, Ridgway EC. Central hypothyroidism. Endocrinol Metab Clin North Am 1992;21:903-19.  Back to cited text no. 2
    
3.Cannavo S, Curto L, Venturino M, Squadrito S, Almoto B, Narbone MC, et al. Abnormalities of hypothalamic-pituitary-thyroid axis in patients with primary empty sella. J Clin Endocrinol Metab 2002;90:5471-7.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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