Central Hypothyroidism Associated With Empty Sella: Literature Review and Case Report

Abstract

Empty Sella Syndrome (ESS) is a rare case of sella turcica malformation, resulting in pituitary gland decrease. It may reveal itself through neurological symptoms, endocrine disorders, visual disturbances or incidental findings during imaging. The urgency of this problem has increased with the widespread use in the diagnosis of the non-invasive method of magnetic resonance imaging (MRI). It can be discovered as part of the investigation of the pituitary disorders, or as an incidental finding when imaging the brain. Practice shows that such patients rarely come with typical complaints thus an extended review of this case is needed to prompt suspicion and aid in the diagnosis of ESS. Few cases of empty sella associated with isolated thyroid-stimulating hormone (TSH) deficiency were published. We report a case of a 46 year-old woman with complaints: edema, dizziness, low blood pressure, hair loss, dry skin. Examinations were performed: ultrasound of the thyroid gland, TSH, FT4 (free thyroxine), FT3 (free triiodothyronine), anti TPO (Antibodies to thyroid peroxidase). Conclusion: patients with TSH, FT4, and FT3 deficiency, should undergo examinations to exclude empty sella as one of the reason of central hypothyroidism. According to the above mentioned the recommendation is to examine all the tropic hormones of the pituitary gland after diagnosing empty sella. Diagnosing central hypothyroidism associated with empty sella helps improving the knowledge and points to different clinical manifestation of empty sella syndrome.