Refractory Hypoglycemia and Seizures as the Initial Presenting Manifestation of Empty Sella Syndrome

Sethuraman, Vinoth Kumar; Viswanathan, Stalin; Aghoram, Rajeswari

doi:10.7759/cureus.2803

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Empty sella syndrome (ESS) occurs in both a primary ESS (PESS) and secondary ESS (SESS) form, respectively. [8] PESS occurs due to poorly understood factors, but conditions like benign intracranial hypertension (BIH) as well as incompetence of the diaphragma sella have been implicated. [4,7] PESS has a prevalence of 5-23.5% in the general population.…”

Section: Discussionmentioning

confidence: 99%

“…[4,7] PESS has a prevalence of 5-23.5% in the general population. [2,7,8] SESS occurs as a result of pituitary surgery, medical treatment of prolactinomas with shrinkage of the tumor, pituitary apoplexy, and Sheehan's syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Among the clinical features associated with ESS apart from visual compromise are headaches and hormonal disturbances; [1,2,4,9] most patients with the condition are asymptomatic. [6,8] Hence, it is important that all cases are worked up with appropriate ophthalmological and endocrine input. When a diagnosis of ESS associated with visual deterioration is made, it is important that an ophthalmologist rules out any other diagnosis as the cause.…”

Section: Discussionmentioning

confidence: 99%

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Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Ouma¹

2020

Surgical Neurology International

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Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pituitary gland, which is the normal constituent of the sella turcica. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. It occurs in a primary ESS, poorly understood form, as well as a secondary ESS form that follows medical or surgical treatment of a pituitary macroadenoma, or else spontaneous hemorrhage into such a tumor. Case Description: A 56-year-old man presenting with deficits of both visual acuity and visual fields in the setting of radiological ESS without associated optic chiasm prolapse is discussed. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months. Conclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. This case illustrates that actual prolapse of the chiasm is neither a prerequisite for visual deterioration nor its reversal the mechanism of visual improvement after chiasmapexy, raising the question of the mechanisms at play in cases such as this. It confirms the role of chiasmapexy in the management of selected cases of ESS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Ouma¹

2020

Surgical Neurology International

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“…The term "empty sella" was first used in 1951 for the neuroradiological or pathological-anatomical exposure of an apparently empty sella turcica. Empty sella syndrome (ESS) is pathophysiologically characterized by either anatomic abnormalities in the diaphragma sellae (primary ESS) or damage to the pituitary by irradiation/surgery, or autoimmunity leading to the availability of "empty" space in the sella (secondary ESS) [1]. The most prevalent hormone deficiency in this syndrome is growth hormone (GH) deficiency, affecting 35 to 61% of adult patients with ESS [2].…”

Section: Introductionmentioning

confidence: 99%

“…Generally the headache is deep, dull and centrally situated. Sometimes headache is very severe along with giddiness and vomiting that before imaging examination [1].…”

Section: Introductionmentioning

confidence: 99%

A Case Report of Empty Sella Syndrome secondary to Hantaan Virus Infection and Review of the Literature

Lou

Zhang

Wang

et al. 2019

Preprint

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Background Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of hemorrhagic fever with renal syndrome (HFRS), while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. The relationship between hantaan virus infection and empty sella syndrome (EES) was reported rarely. Case presentation We herein report a case of EES secondary to hantaan virus infection. This patient was a 54-year-old previously healthy Chinese male. He presented with fever, headache and backache with dizziness and oliguria. Physical examination was notable for hypotention and the signs of conjunctival suffusion. His platelet dropped and the urine protein was positive. The IgM to Hantaan virus and virus RNA were positive. Then he was diagnosed as hemorrhagic fever with renal syndrome. But in his diuretic phase, his 24-hour urine volume was still kept on the level of 10, 000 ml and his blood pressure was obviously higher for a week. Then the examination of pituitary function and brain magnetic resonance imaging were performed. The levels of the hormones were much lower and the magnetic resonance imaging results indicated empty sella. The patient’s symptoms were improved and he was discharged from the hospital soon after hormone replacement therapy. Conclusions The examination of pituitary function and MRI of brain need to be considered to scan ESS and panhypopituitarism in the patients with HFRS accompanied with diabetes insipidus.

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A case report of empty Sella syndrome secondary to Hantaan virus infection and review of the literature

Chen

Zhang

et al. 2020

Medicine

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Rationale: Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in the acute stage of severe clinical forms of hemorrhagic fever with renal syndrome (HFRS), while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after the recovery stage. The relationship between Hantaan virus infection and empty Sella syndrome (ESS) has rarely been reported. Patient concerns: This patient was a 54-year-old previously healthy Chinese male. He presented with fever, headache, and backache with dizziness and oliguria. Physical examination was notable for hypotension and the signs of conjunctival suffusion. His platelets decreased, and his urine protein was positive. Hantaan virus IgM and virus RNA were positive. Diagnosis: He was diagnosed as having HFRS. In his diuretic phase, his 24-hour urine volume was maintained at 10,000 mL, and his blood pressure was higher for a week. Then, he was diagnosed as having ESS after a series of examinations. Interventions: Hormone replacement therapy was given to this patient after the diagnosis “ESS” was made. Outcomes: The patient's symptoms improved, and he was discharged from the hospital soon after hormone replacement therapy. Lessons: Pituitary function examination and brain magnetic resonance imaging (MRI) need to be considered to scan for ESS and panhypopituitarism in the patients with HFRS accompanied by diabetes insipidus.

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Refractory Hypoglycemia and Seizures as the Initial Presenting Manifestation of Empty Sella Syndrome

Cited by 8 publications

References 16 publications

Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

A Case Report of Empty Sella Syndrome secondary to Hantaan Virus Infection and Review of the Literature

A case report of empty Sella syndrome secondary to Hantaan virus infection and review of the literature

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