J Korean Endocr Soc JKES Journal of Korean Endocrine Society 1015-6380 Korean Endocrine Society 10.3803/jkes.2007.22.2.135 Case Report Two Cases of Acromegaly with Empty Sella Syndrome Treated by Long-Acting Release Octreotide Kim Dong Jin Seo Young Jin Kim Nam Hoon Chung Hye Soo Eun Chai Ryoung Choi Hye Jung Kim Hye Sook Yang Sae Jeong Park Juri Yoo Hye Jin Park Soo Yeon Lee Yun Jeong Ryu Ohk Hyun Lee Kye Won Kim Hee Young Seo JiA Kim Sin Gon Kim Nan Hee Choi Kyung Mook Baik Sei Hyun Choi Dong Seop Department of Internal Medicine, Korea University College of Medicine, Korea. 04 2007 20 04 2007 22 2 135 141 06 09 2006 03 11 2006 Copyright © 2007 Korean Endocrine Society 2007

Two cases of typical acromegaly with empty sella syndrome presented to our institution. In the natural course of untreated pituitary adenoma, empty sella syndrome may result from necrosis by infarction or from hemorrhage of the pituitary gland. In our patients, the secretion of growth hormone continued in spite of the existence of empty sella syndrome. In one case, we confirmed the hypersecretion of growth hormone from sella by jugular vein sampling. Medical therapy with somatostatin analogue was attempted because there was no obvious mass in the sella. After 6~12 months of treatment with long-acting release octreotide, clinical features in our patients were improved, and the level of growth hormone and IGF-1 were also normalized.

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The sella cone-down view showed deepening of pituitary fossa and enlargement of bony sella.

Brain MRI shows enlarged bony sella and remnant pituitary mass at right side. Sella is occupied with cerebrospinal fluid.

Chest X-ray shows patchy infiltration on right lower lung and mild cardiomegaly (CT ratio = 0.53).

Skull x-ray shows deepening of bony sella.

Sella MRI shows small pituitary gland and pituitary fossa is replaced by cerebrospinal fluid.