Endocrine Abstracts

An empty sella (ES) develops when cerebrospinal fluid (CSF) compresses pituitary tissue until it lines the sellar floor and walls and lead to shrinkage of pituitary gland. Primary ES occurs when CSF enters the sella from the subarachnoid space that may or may not be associated with increased intracranial pressure. Secondary ES is a result of an injury to the pituitary itself (e.g. pituitary apoplexy) or the consequence of surgical or radiation treatment. Primary ES is most commonly found in middle-aged women with a history of multipl pregnancies and large majority of those women are asymptomatic, therefore it is discovered as an incidentally. However primary ES in men is seen in older age and it is discovered during the diagnostic evaluation of anterior pituitary deficiency. In this case the elderly man admitted with chronic fatique and constipation was presented.

A 73-year-old man had severe constipation in addition to asthenia and adynamia for over the past 4 years. Even, he was followed in surgery inpatient clinic for constipation mimicking acut abdomen syndrome about 1 year ago. He had no history of head injury or surgery. His physical examination revealed a pale face and a decrease in total body hair. Endoscopic and colonoscopic evaluation of gastrointestinal system was normal. His biochemical values are as follows; fasting glucose level was 74 mg/dl (74–100), serum sodium level was 135 mmol/l (136–145), serum potassium level was 5 mmol/l (3.5–5.1), serum FSH level was 0.99 mIU/l (the range for men 1.4–18.1), LH level was 0.36 mIU/l (range for men 1.7–9.6), cortisol level was 2.29 μg/dl (4.3–22.4), free T₄ level was 0.23 pmol/l (0.89–1.76), TSH level was 2.54 μIU/ml (0.35–4.5). ACTH: 2.7 pg/ml (7.2–63). GH <0.03 ng/ml (0.03–2.47), somatomedin c: 41 ng/ml (94–245). Gadolinium magnetic resonance imaging confirmed empty sella with thin rim of pituitary gland. Glucocorticoid and thyroid hormone replacement therapy was then started. His complaints including constipation and asthenia were recovered during the follow-up and he was feeling much better than before.

Therefore, the presented case suggest that constipation with asthenia and adynamia should be considered as the initial manifestation of ES in elderly man.