Primary empty sella syndrome presenting as hyponatremia

Abstract

Empty sella is often an incidental magnetic resonance imaging (MRI) finding. It may be partial or complete and can be primary or secondary due to intracranial hypertension, radiation exposure or pituitary apoplexy. Most of the patients are asymptomatic but features of panhypopituitarism can develop in some. This is a case report of a 70-year-old female who presented with complaints of vomiting, altered sensorium with irritability, generalized weakness, difficulty in speaking, and one episode of seizure. Blood investigations revealed hyponatremia that was euvolemic. On further evaluation, she was found to have decreased cortisol, decreased follicle stimulating hormone, decreased thyroxine, normal prolactin, and thyroid-stimulating hormone values suggestive of panhypopituitarism. MRI brain showed an empty sella. Her serum sodium levels improved after starting glucocoticoids and thyroxine tablets, thereby confirming the diagnosis of panhypopituitarism. In the absence of any history of irradiation, hemorrhage, and surgery, a diagnosis of primary empty sella syndrome was made.