Rare empty sella syndrome found after postoperative hypotension and respiratory failure:A case report
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摘要
BACKGROUND Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache,hypertension, obesity, visual disturbances, cerebrospinal fluid(CSF) rhinorrhoea,or endocrine dysfunction. Herein, we report a rare case of empty sella syndrome discovered after the patient experienced postoperative hypotension and respiratory failure.CASE SUMMARY A 60-year-old man was admitted for further workup of left shoulder pain. He was assessed by the orthopaedics team and booked for internal fixation of the left clavicle. General anaesthesia with a nerve block was administered. His blood pressure continued to decrease post-operation. Endocrine tests were performed,with the results supporting a diagnosis of hypopituitarism with hypocortisolism and hypothyroidism. Brain magnetic resonance imaging demonstrated that the sella was enlarged and filled with CSF, confirming a diagnosis of empty sella syndrome. The patient was started on endocrine replacement therapy. The patient regained consciousness and spontaneous breath finally.CONCLUSION This case highlights the importance of considering pituitary hormone insufficiency in the context of respiratory and hemodynamic failure during the perioperative period.
BACKGROUND Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache,hypertension, obesity, visual disturbances, cerebrospinal fluid(CSF) rhinorrhoea,or endocrine dysfunction. Herein, we report a rare case of empty sella syndrome discovered after the patient experienced postoperative hypotension and respiratory failure.CASE SUMMARY A 60-year-old man was admitted for further workup of left shoulder pain. He was assessed by the orthopaedics team and booked for internal fixation of the left clavicle. General anaesthesia with a nerve block was administered. His blood pressure continued to decrease post-operation. Endocrine tests were performed,with the results supporting a diagnosis of hypopituitarism with hypocortisolism and hypothyroidism. Brain magnetic resonance imaging demonstrated that the sella was enlarged and filled with CSF, confirming a diagnosis of empty sella syndrome. The patient was started on endocrine replacement therapy. The patient regained consciousness and spontaneous breath finally.CONCLUSION This case highlights the importance of considering pituitary hormone insufficiency in the context of respiratory and hemodynamic failure during the perioperative period.
BACKGROUND Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache,hypertension, obesity, visual disturbances, cerebrospinal fluid(CSF) rhinorrhoea,or endocrine dysfunction. Herein, we report a rare case of empty sella syndrome discovered after the patient experienced postoperative hypotension and respiratory failure.CASE SUMMARY A 60-year-old man was admitted for further workup of left shoulder pain. He was assessed by the orthopaedics team and booked for internal fixation of the left clavicle. General anaesthesia with a nerve block was administered. His blood pressure continued to decrease post-operation. Endocrine tests were performed,with the results supporting a diagnosis of hypopituitarism with hypocortisolism and hypothyroidism. Brain magnetic resonance imaging demonstrated that the sella was enlarged and filled with CSF, confirming a diagnosis of empty sella syndrome. The patient was started on endocrine replacement therapy. The patient regained consciousness and spontaneous breath finally.CONCLUSION This case highlights the importance of considering pituitary hormone insufficiency in the context of respiratory and hemodynamic failure during the perioperative period.
引文
1 McLachlan MSF,Williams ED,Doyle FH.Applied anatomy of the pituitary gland and fossa:a radiological and histopathological study based on 50 necropsies.Br J Radiol 1968;41:782-788[DOI:10.1259/0007-1285-41-490-782]
2 Bergland RM,Ray BS,Torack RM.Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases.J Neurosurg 1968;28:93-99[PMID:5638016 DOI:10.3171/jns.1968.28.2.0093]
3 Maira G,Anile C,Mangiola A.Primary empty sella syndrome in a series of 142 patients.J Neurosurg2005;103:831-836[PMID:16304986 DOI:10.3171/jns.2005.103.5.0831]
4 Kim JH,Ko JH,Kim HW,Ha HG,Jung CK.Analysis of empty sella secondary to the brain tumors.JKorean Neurosurg Soc 2009;46:355-359[PMID:19893726 DOI:10.3340/jkns.2009.46.4.355]
5 Ghatnatti V,Sarma D,Saikia U.Empty sella syndrome-beyond being an incidental finding.Indian JEndocrinol Metab 2012;16:S321-S323[PMID:23565413]
6 Thwin M,Brophy BP.Hyperprolactinaemia and the empty sella.J Clin Neurosci 2012;19:605-606[PMID:22245276 DOI:10.1016/j.jocn.2011.06.025]
7 Taieb A,Maha KN,El Abed YH,Beizig AM,Chadli MC,Ach K.Macroprolactinemia and Empty Sella Syndrome.Pan Afr Med J 2017;27:278[PMID:29187947 DOI:10.11604/pamj.2017.27.278.11361]
8 Aijazi I,Abdullah Al Shama FM,Adam Mukhtar SH.Primary Empty Sella Syndrome Presenting With Severe Hyponatremia And Minimal Salt Wasting.J Ayub Med Coll Abbottabad 2016;28:605-608[PMID:28712246]
9 Yang CH,Lin YC,Chou PH,Chen HC,Chan CH.A Case Report of Late Onset Mania Caused by Hyponatremia in a Patient With Empty Sella Syndrome.Medicine(Baltimore)2016;95:e2629[PMID:26871784 DOI:10.1097/MD.0000000000002629]
10 Xu P,He H,Chen Y,Wang C,Zhu Y,Ye X.Osteoporotic fractures and persistent non-fusion of the hand epiphyses caused by empty sella syndrome in an adult:a case report.J Int Med Res 2013;41:1768-1772[PMID:24029021 DOI:10.1177/0300060513490609]
11 Dange N,Redhu R,Kawale J,Mahore A.Primary amenorrhea due to empty sella:an underestimated entity.Turk Neurosurg 2012;22:499-501[PMID:22843475 DOI:10.5137/1019-5149.JTN.3901-10.0]
12 Frost EA.Differential diagnosis of delayed awakening from general anesthesia:a review.Middle East JAnaesthesiol 2014;22:537-548[PMID:25668997]
2 Bergland RM,Ray BS,Torack RM.Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases.J Neurosurg 1968;28:93-99[PMID:5638016 DOI:10.3171/jns.1968.28.2.0093]
3 Maira G,Anile C,Mangiola A.Primary empty sella syndrome in a series of 142 patients.J Neurosurg2005;103:831-836[PMID:16304986 DOI:10.3171/jns.2005.103.5.0831]
4 Kim JH,Ko JH,Kim HW,Ha HG,Jung CK.Analysis of empty sella secondary to the brain tumors.JKorean Neurosurg Soc 2009;46:355-359[PMID:19893726 DOI:10.3340/jkns.2009.46.4.355]
5 Ghatnatti V,Sarma D,Saikia U.Empty sella syndrome-beyond being an incidental finding.Indian JEndocrinol Metab 2012;16:S321-S323[PMID:23565413]
6 Thwin M,Brophy BP.Hyperprolactinaemia and the empty sella.J Clin Neurosci 2012;19:605-606[PMID:22245276 DOI:10.1016/j.jocn.2011.06.025]
7 Taieb A,Maha KN,El Abed YH,Beizig AM,Chadli MC,Ach K.Macroprolactinemia and Empty Sella Syndrome.Pan Afr Med J 2017;27:278[PMID:29187947 DOI:10.11604/pamj.2017.27.278.11361]
8 Aijazi I,Abdullah Al Shama FM,Adam Mukhtar SH.Primary Empty Sella Syndrome Presenting With Severe Hyponatremia And Minimal Salt Wasting.J Ayub Med Coll Abbottabad 2016;28:605-608[PMID:28712246]
9 Yang CH,Lin YC,Chou PH,Chen HC,Chan CH.A Case Report of Late Onset Mania Caused by Hyponatremia in a Patient With Empty Sella Syndrome.Medicine(Baltimore)2016;95:e2629[PMID:26871784 DOI:10.1097/MD.0000000000002629]
10 Xu P,He H,Chen Y,Wang C,Zhu Y,Ye X.Osteoporotic fractures and persistent non-fusion of the hand epiphyses caused by empty sella syndrome in an adult:a case report.J Int Med Res 2013;41:1768-1772[PMID:24029021 DOI:10.1177/0300060513490609]
11 Dange N,Redhu R,Kawale J,Mahore A.Primary amenorrhea due to empty sella:an underestimated entity.Turk Neurosurg 2012;22:499-501[PMID:22843475 DOI:10.5137/1019-5149.JTN.3901-10.0]
12 Frost EA.Differential diagnosis of delayed awakening from general anesthesia:a review.Middle East JAnaesthesiol 2014;22:537-548[PMID:25668997]