![]() Magnetic resonance imaging (MRI) of the brain showed that he had an empty sella with normal-appearing optic nerves and chiasm. The remainder of the neurological and systemic examination was unremarkable. He had no constitutional symptoms of note.Ĭlinical examination was noteworthy for early bilateral optic atrophy associated with bitemporal hemianopia and diminished visual acuity (left 6/12, right 6/18) when corrected with eyeglasses. He had been using prescription eyeglasses over the past couple of decades, but his situation was not helped by two alterations of their power. Keywords: Chiasmapexy, Empty sella syndrome, VisionĪ 56-year-old man with no chronic or comorbid conditions presented with deterioration of vision, mainly in respect of visual fields but also visual acuity over a period of 9 months. It confirms the role of chiasmapexy in the management of selected cases of ESS. 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. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months.Ĭonclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. 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.Ĭase 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. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. The high incidence of endocrine abnormalities in patients with PES mandates that these patients should routinely be subjected to endocrine evaluation to detect these deficiencies early, and appropriate replacement instituted where necessary, thus ensuring them of a better quality of life.Įmpty sella Hyperprolactinemia isolated Growth Hormone Deficiency.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. The most common endocrine dysfunction noted was hyperprolactinemia, which was seen in 5 (20.8%) patients and the most common hormonal deficiency was isolated GH deficiency seen in four patients (12.5%). In subjects with PES, 12 out of 24 (50%) had endocrine dysfunction. ![]() Apart from routine tests, hormonal evaluation included serum thyroid stimulating hormone, T4, cortisol (8 am), prolactin, total testosterone, follicle stimulating hormone, leutinizing hormone, and fasting Insulin like Growth factor 1 (IGF 1) were done.Ī total of 34 patients, diagnosed radiologically to have empty sella, were evaluated and of them 24 had primary empty sella (PES) and 10 had secondary empty sella (SES). A detailed history and clinical examination was done. Patients undergoing a CT/MRI at our center, for various reasons but with the finding of the empty sella were included in this study. To evaluate the clinical and hormonal profile of the patients with an empty sella. This study was undertaken to evaluate the clinical and hormonal profile in patients with empty sella. Empty sella is characterized by the herniation of the subarachnoid space within the sella, which is often associated with some degree of flattening of the pituitary gland.
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