Empty Sella Syndrome
19-Iodocholesterol
Sella Turcica
Hypopituitarism
Large empty sella with an intrasellar herniation of an elongated third ventricle. Case report. (1/49)
A 73-year-old female presented with a large empty sella with herniation of an elongated third ventricle concomitant with herniation of the surrounding subarachnoid space into the sella, manifesting as visual impairment and amenorrhea without galactorrhea. Magnetic resonance imaging and computed tomography cisternography clearly showed the large empty sella, without evidence of either hydrocephalus or benign intracranial hypertension, which is extremely rare. (+info)Pituitary adenomas: early postoperative MR imaging after transsphenoidal resection. (2/49)
BACKGROUND AND PURPOSE: Although there have been several reports on postoperative MR imaging of the sella, immediate postoperative changes (usually within 3 days) have not been extensively analyzed. The purpose of this study was to establish the value of early postoperative MR imaging in differentiating residual tumor from postoperative surgical changes in the sella after transsphenoidal resection of pituitary adenomas. METHODS: Eighty-three patients with surgically proven pituitary adenomas (32 nonfunctioning, 24 prolactin-secreting, 22 growth hormone-secreting, and five prolactin- and growth hormone-secreting tumors) were studied prospectively. All patients underwent dynamic MR imaging within 7 days after surgery. We analyzed the postoperative MR images by focusing on changes in the pituitary gland, signal intensity, resorption of implanted material, and visibility of residual tumor. The patients were divided into four groups according to enhancement pattern of the postoperative pituitary mass: no enhancement, nodular enhancement, peripheral rim enhancement, and a combination of nodular and peripheral rim enhancement. RESULTS: Postoperative changes included resorption of implanted material and reexpansion of the pituitary gland. In 22 patients, residual tumors were found, and all patients showed nodular or combined enhancement. The residual tumors were confirmed by immediate reoperation in three patients, by hormonal assay and follow-up MR images in 11 patients with functioning adenomas, and by growth of the tumor on follow-up MR images in eight patients with nonfunctioning adenomas. Forty-eight patients showed no enhancement and 13 patients showed peripheral rim enhancement. CONCLUSION: Early postoperative dynamic MR imaging after transsphenoidal resection in pituitary adenoma is very effective in differentiating residual tumor from postoperative surgical changes. (+info)Chasing hyponatraemia: unusual presentation. (3/49)
Two females, in their sixth decade, presented with recurrent episodes of headache, vertigo, vomiting and altered sensorium. Both patients had persistent hyponatraemia as the only clue. Detailed investigations revealed a pituitary aetiology in both. One patient had a pituitary microadenoma while the other had an empty sella syndrome. The diagnosis and management is discussed and the relevant literature reviewed. (+info)Spontaneous cerebrospinal fluid rhinorrhea associated with chronic renal failure--case report. (4/49)
A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. Neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca++ and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH2O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extra-osseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca++ mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation. (+info)Treating hyponatremia in an empty sella syndrome patient complicated with possible myelinolysis. (5/49)
Hyponatremia as the presenting manifestation of empty sella syndrome is rare. There is little clinical experience in the management of this problem and its possible therapeutic complications. We herein report on a 44-year-old woman with a past history of massive postpartum hemorrhage who was admitted because of hyponatremia and disturbed consciousness. Initial biochemical data suggested the effects of antidiuretic hormone, but fluid restriction alone offered limited benefit. Later, hormonal levels indicated hypopituitarism. Magnetic resonance imaging and cisternography led to a diagnosis of empty sella. Although glucocorticoid substitution was initiated and the clinical condition initially improved, possible myelinolysis subsequently became a complication. With early recognition and immediate replacement of hypotonic fluid, the patient completely recovered. We report this case to illustrate the fact that glucocorticoid substitution and concurrent fluid restriction can probably lead to myelinolysis in empty sella syndrome patients. We suggest that the serum sodium level should be frequently monitored and that much more attention should be paid to the neurologic signs when substituting glucocorticoids in these patients, even though the increment in the serum sodium level is acceptable. Once possible myelinolysis develops, early recognition is critical, and the immediate replacement of hypotonic fluid is suggested. (+info)Empty sella syndrome: incidental findings at computerised tomography. (6/49)
A case is presented of a 43-year-old female patient who presented with severe dizziness, neck pain and headache. Clinical examination revealed diplopia with a horizontal gaze. Plain skull radiographs showed an enlarged sella turcica with no abnormal intracraial calcifications. Pre and post contrast axial and post contrast coronal computerised tomography scans through the sella turcica were done. An enlarged sella turcica filled with cerebrospinal fluid was demonstrated. (+info)Clinical report of 28 patients with Sheehan's syndrome. (7/49)
The aim of the present study was to determine the clinical and hormonal characteristics with Sheehan's syndrome in 28 cases that we had diagnosed and followed in the last 20 years. Twenty-eight patients with Sheehan's syndrome, diagnosed and followed at our University Endocrinology Clinic in the last 20 years were reported in the study. Medical history, physical examination, routine laboratory examinations, pituitary hormone analysis, CT and/or MRI scan of the sella of the patients were reviewed. All patients had a history of massive hemorrhage at delivery and physical signs of Sheehan's syndrome. Twenty-six of them lacked postpartum milk production, followed by failure of resumption of menses. There were 9 subjects with disturbances in consciousness associated with hyponatremia on admittance. All 28 patients had secondary hypothyroidism, adrenal cortex failure, hypogonadotrophic hypogonadism and growth hormone deficiency. Diabetes insipidus has not been found in any patient. Empty sellae were revealed in 8 patients by CT and/or MRI scan. Sheehan's syndrome is still encountered in clinical practice occasionally. If not diagnosed early, it could cause increased morbidity and mortality. The most important clues for diagnosis of Sheehan's syndrome are lack of lactation and failure of menstrual resumption after a delivery complicated with severe hemorrhage. (+info)A case of autoimmune insulin antibody syndrome associated with polymyositis, empty sella and apparent high urinary output of immunoreactive insulin. (8/49)
Patients with autoimmune insulin antibody are characterized by hypoglycemic attacks and antibodies to insulin in serum without prior insulin administration. In the present report, a patient with hypoglycemia due to autoimmune insulin antibody associated with primary empty sella syndrome and polymyositis appeared to have high urinary immunoreactive insulin (IRI) in the face of normal urinary C peptide. Consequently, the urinary IRI/C peptide ratio was apparently high. The amelioration of hypoglycemic attacks and polymyositis by prednisolone treatment was accompanied by the disappearance of the antibodies and complete normalization of the urinary IRI and IRI/C peptide ratio. No comparable rise in the urinary IRI and IRI/C peptide ratio was observed in the patients with other disorders studied. Glucose clamp and glucose tolerance study showed decreased sensitivity to exogenous or newly secreted insulin, prolonged half disappearance time of serum insulin, and normal disappearance of blood glucose. These results were consistent with the idea that autoantibodies buffered the effect of exogenous or newly secreted insulin and maintained a relatively constant level of serum free insulin which was not high enough when a large amount of glucose was loaded, but was too high after prolonged fasting, which eventually caused hypoglycemic attacks. (+info)Empty Sella Syndrome is a condition characterized by the absence or near-absence of the pituitary gland in the sella turcica, a bony structure at the base of the skull that houses the pituitary gland. This can occur due to the herniation of the arachnoid membrane, which surrounds the brain and spinal cord, into the sella turcica, compressing or replacing the pituitary gland.
In some cases, Empty Sella Syndrome may be asymptomatic and discovered incidentally on imaging studies. However, in other cases, it can lead to hormonal imbalances due to the disruption of the pituitary gland's function. Symptoms may include headaches, vision changes, menstrual irregularities, fatigue, and decreased libido. Treatment typically involves addressing any underlying hormonal deficiencies with medication or hormone replacement therapy.
19-Iodocholesterol is a type of radiopharmaceutical, which is a drug that contains a small amount of radioactive material. It is used as a diagnostic agent in medical imaging tests, specifically in a test called a liver-spleen scan.
The drug is given orally, and it is absorbed by the body and taken up by the liver and spleen. The radioactive iodine in the drug emits gamma rays, which can be detected by a special camera called a gamma camera. This allows doctors to create images of the liver and spleen and assess their size, shape, and function.
19-Iodocholesterol is used to diagnose various conditions that affect the liver and spleen, such as tumors, abscesses, or inflammation. It is a safe and effective diagnostic tool when used properly, but like all medical procedures, it carries a small risk of side effects, including allergic reactions and radiation exposure.
The Sella Turcica, also known as the Turkish saddle, is a depression or fossa in the sphenoid bone located at the base of the skull. It forms a housing for the pituitary gland, which is a small endocrine gland often referred to as the "master gland" because it controls other glands and makes several essential hormones. The Sella Turcica has a saddle-like shape, with its anterior and posterior clinoids forming the front and back of the saddle, respectively. This region is of significant interest in neuroimaging and clinical settings, as various conditions such as pituitary tumors or other abnormalities may affect the size, shape, and integrity of the Sella Turcica.
Hypopituitarism is a medical condition characterized by deficient secretion of one or more hormones produced by the pituitary gland, a small endocrine gland located at the base of the brain. The pituitary gland controls several other endocrine glands in the body, including the thyroid, adrenals, and sex glands (ovaries and testes).
Hypopituitarism can result from damage to the pituitary gland due to various causes such as tumors, surgery, radiation therapy, trauma, or inflammation. In some cases, hypopituitarism may also be caused by a dysfunction of the hypothalamus, a region in the brain that regulates the pituitary gland's function.
The symptoms and signs of hypopituitarism depend on which hormones are deficient and can include fatigue, weakness, decreased appetite, weight loss, low blood pressure, decreased sex drive, infertility, irregular menstrual periods, intolerance to cold, constipation, thinning hair, dry skin, and depression.
Treatment of hypopituitarism typically involves hormone replacement therapy to restore the deficient hormones' normal levels. The type and dosage of hormones used will depend on which hormones are deficient and may require regular monitoring and adjustments over time.