Category: Pituitary Disorders/Neuroendocrinology

Monitor: 21

21 - EMPTY SELLA SYNDROME PRESENTING WITH HEMIPARESIS AND MYXEDEMA CRISES

Thursday, Apr 25
11:00 AM – 11:30 AM

Objective :

Aim To report a case of a 62 year old male who presented with hemiparesis and CT evidence of empty sella syndrome.


Empty sella syndrome is a condition in which the pituitary gland is partially or totally absent from the pituitary fossa. It is a syndrome resulting from herniation of the arachnoid into the sella space leading to compression of the pituitary gland. In most cases, it is asymptomatic and found on imaging as an incidental finding. In symptomatic cases it may present with headaches, CSF rhinorrhoea, visual field defects and as partial or panhypopituitarism. Hemiparesis is not a usual presentation of this syndrome.


Methods : N/A


Results : n/a


Discussion :

 A 62 year old male who presented with a one week history of sudden onset weakness of the right upper and lower limb with associated numbness. There was no history of headache, vomiting, facial deviation, slurred speech seizures or altered consciousness. He was a known hypertensive but had not had a TIA or stroke in the past. He  had periorbital swelling , cold intolerance, weight gain, lethargy . On examination he was pale with periorbital swelling, pedal oedema and hyperpigmentation of the face and right foot. He was conscious, alert and well oriented but with a right sided hemiparesis . He had an elevated blood pressure (BP=170/95mmHg), normal pulse rate (76bpm), cardiomegaly.


The only CT scan finding was a CSF filled sella turcica with the pituitary gland compressed against its floor.  Homone profile showed primary hypothyroidism viz:  Free T3 -<0.4 (2.8-7.1pmol/l), Free T4 -1.3 (10.6-22pmol/l) and TSH- 37.74(0.27-4.2U/IU/L) and mildly reduced serum testosterone-5.2nmo/l (5.3-19.6),FSH-3.2 U/L (1.5-12.4),LH-6.4U/L(1.7-8.6), Prolactin-10.2ng/ml(4.1-18.4),ACTH-11.6pg/l(2.8-64)He had anaemia -(PCV 27%).He had elevated total cholesterol -6.76mmol/l(0-5.18) and low density lipoprotein cholesterol -5.18mmol/l(0--3.36). He was initially placed on daily dose of levothyroxine  25mcg, atovarstatin 20mg, clopidogrel 75mg Amlodipine 10mg and frusemide 40mg but while he was still being evaluated, he developed features of myxedema crises (loss of consciousness, hypotension, hypothermia) and was managed  in the Intensive care unit with oral levothyroxine 100ug (in the absence of parenteral levothyroxine) , IV hydrocortisone, glucose infusion, antibiotics with other supportive care. He responded well to the treatment and was maintained on 100ug of levothyroxine and 5mg bd prednisolone(in absence of hydrocortisone tablet) at discharge. He is currently in a euthyroid state with normal lipid profile  though still has residual hemiparesis.


Conclusion :

Empty sella syndrome is a rare but important case in clinical practice  with scarce data in Nigeria. 

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Kariba Akhidue

Consultant Physician/Endocrinologist
University of Port Harcourt Teaching Hospital
Port Harcourt, Rivers, Nigeria

Dr (Mrs)Kariba Akhidue is a young Consultant Physician/Endocrinologist/ Diabetologist, working in the department of Internal Medicine and Endocrinology of the University of Port Harcourt Teaching Hospital (UPTH) and also a Part time Consultant Endocrinologist / Lecturer at the Rivers State University Teaching Hospital.(RSUTH).She was born on 7th October 1979 and hails from Buguma in Asari-Toru Local Government Area of Rivers State, Nigeria.
She attended Federal Government Girls College (FGGC) Abuloma where she graduated in 1996 with honours. She went on to study Medicine and Surgery at the University of Port Harcourt. and graduated in 2003 with the MBBS degree. Afterwards, she completed her internship at Braithwaite Memorial Specialist Hospital(now RSUTH),Port Harcourt. She became a Registrar in internal medicine at UPTH in 2006 and then went on to be a Senior Registrar in 2012
Kariba worked as a Senior Registrar until October 2015, when she had the best result in the subspecialty Fellowship examinations of the West African College of Physicians (Int. Med-Endocrinology) and became a Consultant
. In December 2015 she won a grant from the International Diabetes Federation where she presented her research work at the World Diabetes Congress in Vancouver, Canada. She has also published articles in peer reviewed journals and presented papers in both local and international conferences. She is a member/fellow of a number of professional associations including the West African College of Physicians, Endocrine and Metabolism Society of Nigeria, American Association of Clinical Endocrinologists, European Association for the Study of Diabetes, Pan African Diabetes Foot Study Group among others.
Kariba is married to Dr Dennis Akhidue, a Consultant Haematologist and is a mother of 3 (three) lovely children. Her hobbies are reading ,researching, singing and travelling, Shecan be described as calm, soft-spoken and intelligent.

Sunday Chinenye

CONSULTANT PHYSICIAN/ ENDOCRINOLOGIST
UNIVERSITY OF PORT HARCOURT
PORT HARCOURT, Rivers, Nigeria


Sunday Chinenye, a Professor of Medicine and Endocrinology, is a 1987 MBBS graduate of the premier University of Ibadan, Ibadan, Nigeria

He holds the post-graduate fellowship of the West African College of Physicians in Internal Medicine and Endocrinology. He is also a fellow of the American College of Endocrinology and Nigerian Society of Endocrinology and Metabolism

His core research interests are Internal Medicine, Diabetes/Endocrinology, Advocacy, HIV Medicine & Medical Education.He was born on 21st May 1963(55 years old); attended Christ Church School, Akwete-Ndoki (1971-1976) and had his secondary education at Ndoki Grammar School, Ndoki between 1976-1981. He was nurtured and brought up by his devout Christian parents (all of blessed memory), grew up in his hometown where he was groomed with the ethics and traditions of his people.
He embarked upon a highly distinguished medical career at the University of Ibadan in 1981 and finished at the correct record time of 6 years before proceeding for his Internship, NYSC and subsequently post-graduate medical education.

He is an Honorary ConHe was born on 21st May 1963(55 years old); attended Christ Church School, Akwete-Ndoki (1971-1976) and had his secondary education at Ndoki Grammar School, Ndoki between 1976-1981. He was nurtured and brought up by his devout Christian parents (all of blessed memory), grew up in his hometown where he was groomed with the ethics and traditions of his people.
He embarked upon a highly distinguished medical career at the University of Ibadan in 1981 and finished at the correct record time of 6 years before proceeding for his Internship, NYSC and subsequently post-graduate medical education.

He is an Honorary Consultant Physician/Endocrinologist; the pioneer coordinator of Anti-Retroviral programme in University of Port Harcourt Teaching Hospital. For a practice period spanning 31 years-plus, Prof. Sunday Chinenye has published over 75-peer-reviewed Articles in local & internationals journals and conference papers, Ten (10) books including a Chapter in a book, two technical Reports; delivered over a hundred public lectures during CME/CPD sessions and as key-opinion-leader for pharmaceutical companies. He has served in several committees and boards in University of Port Harcourt and delivered the 126th Inaugural Lecture of University of Port Harcourt on Thursday 15th October, 2015, titled “LIVING WITH DIABETES IN NIGERIA- the Care, Cure and Prevention”.

Victoria E. Gomba

SENIOR REGISTRAR / ENDOCRINOLOGIST
RIVERS STATE UNIVERSITY TEACHING HOSPITAL, PORT HARCOURT, RIVERS STATE ,NIGERIA
PortHarcourt, Nigeria

She is a senior registrar of the Endocrine Diabetes and Metabolism Unit of the Rivers State University Teaching Hospital (RSUTH), Port Harcourt Rivers state Nigeria .She has a Bachelors of Medicine and Surgery degree from the University of Port Harcourt Nigeria in 2004. She is a Member of the West African College Of Physicians (MWACP 2015).

She worked as a Senior registrar in the Endocrinology Diabetes and metabolism Unit of the Department of Internal Medicine of University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt Nigeria from March 2016 to May 2018. She was a registrar in the department of internal medicine of the UPTH from 2012 to 2015 and a Medical officer in the department of internal Medicine at the RSUTH, Port Harcourt Rivers State from 2010 till 2012. She also worked as a resident Medical officer at Atinu Critical Care Hospital in Port Harcourt Rivers State from 2007 to 2010. From 2006 to 2007 she was the resident Medical officer of the Enugwukwu General Hospital in Anambra state Nigeria as part of the National Youth service Programme. She had her internship training at the UPTH Port Harcourt Rivers State from 2005 to 2006 where she was awarded with the best house officer award by the Association of resident doctors of UPTH Port Harcourt Rivers State Nigeria.

She is involved in teaching medical students, house officers and residents as well as research .
She has interest mainly in diabetology, thyroidotology and reproductive endocrinology and has attended several conferences in these areas. Her research works include;
- Premarital sexual behaviours in adolescents in Port Harcourt (unpublished),
-Myxedema megacolon; A rare complication of hypothyroidism (A paper presented at the Endocrine and Metabolism Society of Nigeria Conference 2017)
-Profile of thyroid dysfunction in chronic kidney disease patients in Port Harcourt Nigeria (ongoing).
She is a member of the Nigerian Medical Association (NMA), Diabetes association of Nigeria (DAN) Rivers State branch and Endocrine and Metabolic Society Of Nigeria EMSON.
She is happily married.

Goodleave N. Owhonda

Consultant Physician/Cardiologist
Member Nigerian Cardiac Society
Port Harcourt, Nigeria

Born 24/12/54 , attended County Grammar school, ikwerre etche from 1967 -1972,native of Rumuoro in Ogbakiri,Rivers State. Nigeria, married with three children.I have been in medical practice since 1980 when I qualified as a doctor.My hobies are reading and playing tenis.