Panhypopituitarism Caused by Empty Sella Syndrome in a Male Patient: A Case Report

Abstract

Background: Empty sella syndrome (ESS) is a rare condition characterized by herniation of cerebrospinal fluid into the sella turcica, resulting in compression of the pituitary gland. Although sometimes asymptomatic, ESS may lead to varying degrees of pituitary hormone deficiencies, including panhypopituitarism.

Methods: A 43-year-old male who was referred to the endocrinology clinic for evaluation of persistently low free thyroxine (T4) levels despite normal thyroid-stimulating hormone (TSH). The patient presented with chronic fatigue. Hormone assays and an electrolyte panel were requested alongside MRI pituitary.

Results: Laboratory investigations revealed secondary hypothyroidism, secondary adrenal insufficiency, hypogonadotropic hypogonadism, low insulin-like growth factor 1 (IGF-1), and hyperprolactinemia, which is consistent with panhypopituitarism. Pituitary MRI demonstrated empty sella syndrome. A DEXA scan was requested which revealed osteopenia. The patient was started on hydrocortisone replacement therapy, followed by thyroxine, testosterone, and cabergoline. At three-month follow-up, the patient reported symptomatic relief with normal laboratory results.

Conclusion: This case demonstrates that panhypopituitarism caused by primary empty sella syndrome can present with subtle symptoms. This stresses the importance of pituitary evaluation and MRI in diagnosing and guiding treatment in patients with hormonal abnormalities.