Journal List > Kosin Med J > v.29(2) > 1057024

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


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.


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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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