Endocrine Abstracts

Introduction: Unexplained weight loss is a cause for concern; it might indicate an underlying condition, usualy a catabolic state. In empty sella, the progressive loss of pituitary hormone secretion is usually a slow process, with symptoms varying from one person to another and depends on the underlying cause. Usually the weight remain relatively constant or we could have several arguments for weight gain.

Case report: A 57 years old man with significant weight loss–about 15 kg in the last 4 months, also associating marked physical asthenia, presented in our department to rule out an endocrine pathology, such as hyperthyroidism or primary adrenal insufficiency. All the symptoms had a sudden onset after the summer vacation and 2 weeks prior to presentation he acused musclular weekness and mialgia. The basic blood tests did not show anything wrong and he had no personal pathological background. The hormonal profile showed hypothyroxinemia with inappropriately TSH: FT4 = 0.5 ng/dl (n = 0.7–1.48), TSH = 4.49 micro UI/ml (n = 0.35–4.94) ; hypocortisolemia with low ACTH: plasma Cortisole = 1.23 microg/dl (n = 6.02-18.4), ACTH = 4.29 pg/ml (n = 7.2–63.3), low normal IGF1 level: 79.9 ng/ml (n = 36-200 for gender and sex), normal gonadotropic axis and normal prolactin level; the electrolytes level was normal. He also had a high level of anti-thyroperoxidase (ATPOs): 781 UI/ml (n <5.6), MRI of the pituitary gland was suggestive for empty sella. Substitutional treatment was established on corticotropic and thyrotropic lines, with the rapid disappearance of the symptomatology, the patient having no myalgia and gradually returning to the previous weight.

Looking for the cause of weight loss but also the explanation of empty sella syndrome, the patient also performed chest radiography and abodominopelvic ultrasound, the results being within normal limits–no sign of sarcoidosis or other granulomatous diseases, no tumor; he had no radiation or trauma, no infection and no sign of pituitary infarctisation. The presence of high ATPOs and partial hypopituitarism are suggestive for autoimmune hypophysitis.

Conclusion: Weight loss can be explained by secondary adrenal insufficiency and rarely by decreased intestinal absorption in hypothyroidism, but this is unusual and not significant in hypopituitarism. The symptomatology of our patient was suggestive of adrenal insufficiency, but the diagnosis of empty sella was a surprise. However, evolution of empty sella may be long-lasting and gradual, and rapid weight loss may be due to decompensation.