Endocrine Abstracts

Introduction: Acromegaly is an acquired disorder related to excessive production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). It is characterized by progressive somatic disfigurement and systemic manifestations. Empty sella (ES) is an anatomical condition comprising sella turcica that is partially or completely filled with cerebrospinal fluid mainly due to intrasellar herniation of subarachnoid space. Primary ES may be associated with endocrine dysfunction and intracranial hypertension. Primary ES has to be distinguished from secondary ES, which has been linked to iatrogenic factors (surgery, radiation, medical treatment) or may be due to pituitary tumor apoplexy or autoimmune hypophysitis. Here, we describe a patient who presented with clinical and biochemical features of acromegaly and who had an empty sella on pituitary MRI.

Case: A 73-year-old male patient was consulted to our clinic for acromegalic phenotype while planning to be operated due to colorectal adenocarsinoma. The patient noticed gradual enlarging of his hands, feet, lips, and nose for 30 years, but never consulted to any clinician for this reason. Physical examination revealed typical acromegalic features. Visual field defect was not detected. Laboratory data showed elevated serum growth hormone (GH; 20.6 ng/ml)(normal <3 ng/ml) and insulin-like growth factor-1 (IGF-1; 531 ng/ml)(normal, 69–200 ng/ml). An oral glucose tolerance test (OGTT) showed no suppression of GH values. Serum levels of prolactin (PRL), adrenocorticotropic hormone (ACTH), cortisol (CS), thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), andluteinizing hormone (LH) were normal. T1-weighted magnetic resonance imaging (MRI) revealed an empty sella. Thorax computed tomography (CT), abdomen CT and 18F-FDG PET-CT did not have any finding consisted with ectopic GH secretion. Adenoma releasing growth hormone releasing hormone (GHRH) was not considered as GHRH was in the normal range (<100 mg/dl).He was treated with Octreotide LAR 20 mg per 28 days. At 6^th month evaluation, serum GH and IGF-1 levels were decreased to 5.45 ng/ml and 274 ng/ml (normal, 69–200 ng/ml), respectively.

Conclusion: The mechanism underlying the association of acromegaly and empty sella remains unclear. However, our patient did not have a history of pituitary apoplexy, we should keep in mind that apoplexy on existing pituitary adenoma and then formation of necrosis can proceed empty sella. Yet, we have not found any reason for secondary empty sella in our patient. So, he has probably primary empty sella.