Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
Journal website https://www.jofem.org

Case Report

Volume 10, Number 5, October 2020, pages 144-153


Adrenal Insufficiency due to Total Primary Empty Sella Syndrome

Figures

Figure 1.
Figure 1. Cranial computed tomography scan from the emergency room. An empty sella is confirmed in the pituitary gland (red arrow), with a height of 1 mm.
Figure 2.
Figure 2. Cranial magnetic resonance imaging scan from the emergency room. An empty sella is confirmed in the pituitary gland (red arrow), with a height of 1 mm. Cerebrospinal fluid has filled the sella turcica and its intensity is the same as the cerebral ventricle (iso-intensity in T1-weighted image (a), high intensity in T2-weighted image (b)).
Figure 3.
Figure 3. Daily ACTH and cortisol secretions. ACTH: adrenocorticotropic hormone.
Figure 4.
Figure 4. Result of insulin tolerance test. ACTH: adrenocorticotropic hormone; GH: growth hormone.
Figure 5.
Figure 5. Result of anterior pituitary function test through combined intravenous administration of four hypothalamic releasing hormones. A FT4 test was performed twice: preload, and 120 min later. TSH: thyroid-stimulating hormone; FT4: free thyroxine; LH: luteinizing hormone; FSH: follicle-stimulating hormone; ACTH: adrenocorticotropic hormone; PRL: prolactin; GH: growth hormone.

Table

Table 1. Result of Laboratory and Urine Examination
 
Parameter (units)Measured valueNormal value
HbA1c: hemoglobin A1c; NGSP: National Glycohemoglobin Standardization Program.
Blood
  White blood cells (103/µL)12.53.8 - 8.5
  Red blood cells (106/µL)4.753.78 - 4.97
  Platelets (103/µL)293131 - 365
  Aspartate transaminase (IU/L)2312 - 31
  Alanine aminotransferase (IU/L)208 - 40
  Lactic acid dehydrogenase (IU/L)228110 - 210
  Gamma-glutamyl transpeptidase (IU/L)239 - 49
  Total bilirubin (mg/dL)1.180.3 - 1.2
  Total protein (g/dL)7.46.7 - 8.3
  Albumin (g/dL)3.43.9 - 4.9
  Creatine kinase (IU/L)17550 - 170
  Blood urea nitrogen (mg/dL)6.88 - 22
  Creatinine (mg/dL)0.60.4 - 0.8
  Amylase (IU/L)5039 - 134
  Sodium (mEq/L)122138 - 146
  Potassium (mEq/L)3.73.6 - 4.9
  Chloride (mEq/L)8699 - 109
  Calcium (mg/dL)87.1 - 10.1
  Low-density lipoprotein cholesterol (mg/dL)109.566 - 141
  High-density lipoprotein cholesterol (mg/dL)3941 - 95
  Triglyceride (mg/dL)9630 - 150
  Plasma glucose (mg/dL)18470 - 109
  HbA1c (NGSP) (%)6.14.6 - 6.2
  C-reactive protein (mg/dL)0.070 - 0.4
  Procalcitonin (ng/mL)0.10 - 0.5
  Ammonia (µg/dL)2420 - 70
Spotted hormone
  Thyroid-stimulating hormone (µIU/mL)4.0240.541 - 4.261
  Free triiodothyronine (pg/mL)2.052.39 - 4.06
  Free thyroxine (ng/dL)0.860.72 - 1.52
  Aldosterone (pg/mL)72.335.7 - 240
  Adrenocorticotropic hormone (pg/mL)14.97.2 - 63.3
  Prolactin (ng/mL)6.16.12 - 30.54
  Adrenaline (ng/mL)0.040 - 0.1
  Noradrenaline (ng/mL)0.250.1 - 0.5
  Dopamine (ng/mL)< 0.010 - 0.3
  Plasma renin activity (ng/mL/h)0.60.2 - 3.9
  Cortisol (µg/dL)24.94.5 - 21.1
  Antidiuretic hormone-free water (pg/mL)4.70 - 2.8
  Growth hormone (ng/mL)0.480.126 - 9.88
Urine
  Urobilinogen--
  Occult blood reaction--
  Protein--
  Sugar3+-
  pH7.55 - 7.5
  Ketone body1+-
  Bilirubin--
  Nitrite--
  White blood cells--
  Sodium (mEq/L)7040 - 156
  Potassium (mEq/L)12.316 - 56
  Chloride (mEq/L)51117 - 127
  Creatinine (mg/dL/day)84.9437 - 300
  Cortisol (µg/day)58.826 - 187