Endocrine Abstracts

Introduction: Hypoglycaemia in a non-diabetic patient is not a common condition and is often a diagnostic challenge.

Case report: A 78-year-old gentleman was admitted to hospital by paramedics when his neighbours found him unresponsive. He had a background history of primary hypothyroidism. Capillary blood glucose reading done on site was 1.0 mmol/l. He received intravenous glucose which resulted in prompt recovery. All other vital signs were normal.

Clinical examination was unremarkable. He had normal blood count, inflammatory markers, renal and liver function tests. He had an inadequate response to synacthen with basal serum cortisol of 137 nmol/l and peak serum cortisol of 381 nmol/l at 60 min. Serum ACTH level is still pending but we expect it to be suppressed, consistent with secondary hypocortisolism. There was evidence of secondary hypogonadism with low testosterone level at 3.2 nmol/l (NR 7–26 nmol/l) and inappropriately normal gonadotrophins (FSH 9.3 U/l (NR 2–17 U/l), LH 9.2 U/l (NR 1–7)). Rest of the basal anterior pituitary profile included a low IGF1 of <3.3 nmol/l (NR 7.7 to 24.6 nmol/l), TSH 0.33mu/l (NR 0.25–5mu/l), free T₄ 19.1 pmol/l (NR 12–25 pmol/l) and prolactin 144 mu/l.

An MRI scan of the pituitary gland was consistent with an empty sella. Patient was treated with intravenous hydrocortisone and is now maintained on oral hydrocortisone. We shall review him in the clinic to discuss testosterone supplementation and assess his GH axis given his low IGF1 levels.

Conclusion: Empty sella is usually an incidental finding on an MRI scan. Approximately one third of these patients present with endocrinopathies and neurological symptoms.

Our patient presented with a significant hypoglycaemic episode which is a recognized though a rare presentation of empty sella syndrome and this case serves as a reminder of this rare cause of hypoglycaemia in a non-diabetic patient.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.