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

Soo Kyoung Kim; Sung Su Kim; Bo Ra Kim; Jung Hwa Jung; Jae Hoon Jung; Jong Ryeal Hahm

doi:10.7180/kmj.2014.29.2.151

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Kim, Kim, Kim, Jung, Jung, and Hahm: A Case with Empty Sella Syndrome Combined with Multiple Anterior Pituitary Hormone Deficiencies Presenting as Hypoglycemic Coma

Case Report

Kosin Medical Journal 2014;29(2):151-155.

Published online: 18 December 2014

DOI: https://doi.org/10.7180/kmj.2014.29.2.151

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

Soo Kyoung Kim^1,², Sung Su Kim¹, Bo Ra Kim¹, Jung Hwa Jung^1,², Jae Hoon Jung^1,², Jong Ryeal Hahm^1,^2,

¹Department of Internal Medicine, Gyeongsang National University, Jinju, Korea

²Institute of Health Sciences, GyeongsangNational University, Jinju, Korea

Corresponding Author : Jong Ryeal Hahm, Department of Internal Medicine, Gyeongsang National University School of Medicine, 79, Gangnam-ro, Jinju, 660-702, Korea TEL: +82-55-750-8736 FAX: +82-55-758-9122 E-mail: jrhahm@gnu.ac.kr

Received 4 September 20134 September 2013 Accepted 16 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 pg/dᄂ)· 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.

Keywords: ACTH deficiency, Empty sella, Hypoglycemia

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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.

Table 1.

Basal and stimulated levels of pituitary and target organ hormones

	Provocation test	Basal	30 min	60 min	90 min
Glucose (mg/dL)		61
TSH (mlU/L)	TRH (0.5 mg i.v.)	4.98	15.83	13.92	11.19
Prolactin (ng/mL)	TRH (0.5 mg i.v.)	17.47	100.60	8i.24	52.84
LH (mJU/mL)	LH-RH (100 μ§ i.v.)	3.10	41.51	45.01	36.33
FSH (mlU/mL)	LH-RH(100 ng i.v.)	4.89	9.60	11.27	10.69
Testosterone (ng/mL)		6.69
ACTH (pg/mL)		1.0
	Tetracosactide (250
Cortisol (Mg/dL)		0.17	0.22	0.27
GH (ng/mL)		0.29
IGF-1 (ng/dL)		43.6

IGF-1: insulin-like growth factor-1, FSH: follicle-stimulating hormone, LH: luteinizing hormone, LH-RH: luteinizing hormone-releasing hormone, TRH: thyrotropin-releasing hormone, TSH: thyroid-stimulating hormone mpty sella.

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