Endocrine Abstracts

Background: Empty sella (ES) is often an incidental imaging finding, associated or not with the following symptoms: headache, hypopituitarism or visual impairment. Two etiological forms are described: primary ES due to a combination of increased spinal fluid pressure and a defect in the sella diaphragm and secondary ES due to the shrinkage of the pituitary gland (after pituitary surgery, radiation, apoplexy, hypophysitis or neurosarcoidosis).

Clinical case: We present the case of a male patient diagnosed with giant empty sella and partial pituitary insufficiency 20 years after radiotherapy for nasopharyngeal cancer. A male patient, aged 37 years, presented in our service for daily headache, episodes of diplopia, memory and concentration disturbances, asthenia, dizziness, somnolence, weight gain and diminished libido. In the two months previous the consultation he had two alarming episodes of loss of consciousness. Hormonal dosages showed a partial thyrotropic and gonadotropic insufficiency with normal prolactin, IGF1 and cortisol. MRI investigation showed a giant empty sella invading the sphenoid sinus, with very scarce pituitary tissue. In the pathological history of the patient, an episode of radiotherapy at age 17 for nasopharyngeal cancer is noted followed by complete remission of the tumor. At the time and during the 10 years follow-up, no anomaly of the pituitary region was noted. Radiotherapy is probably the cause of the pituitary atrophy and the secondary empty sella. Substitutive treatment with thyroxin and testosterone was prescribed, resulting in significant clinical improvement: weight loss, remission of memory and concentration disturbances, asthenia, dizziness, somnolence, and diminished libido. The headache and the visual disturbances also improved. A yearly follow-up is recommended in order to assess the pituitary function and the substitutive treatment. As the empty sella is completely invading the sphenoid sinus, the occurrence of a nasal cerebrospinal fluid leak is a concerning perspective.

Conclusion: We present the very rare case of a giant empty sella and pituitary partial insufficiency, secondary to radiotherapy for nasopharyngeal cancer, showing the necessary follow-up of these patients, even longtime after the treatment.