Delayed presentation of Sheehan's syndrome: a case report.

Sheehan's syndrome, though rare, is still one of the commonest causes of hypopituitarism in developing countries like ours. The clinical presentation is variable with abrupt or insidiously developing pituitary insufficiency after a heavy intrapartum or postpartum haemorrhage. We present an elderly lady with this syndrome who had slowly progressive panhypopituitarism 24 years after a severe haemorrhage associated with the delivery of triplets.

Freqüência de depressäo em indivíduos com diagnóstico de sela vazia / Depression frequency in subjects with empty sella diagnostic

Com a finalidade de investigar a possível associação entre a presença de sela vazia e depressão foram avaliados 11 pacientes com esse diagnóstico anátomo-radiológico e 10 indivíduos com imagem tomográfica selar normal. O diagnósitco de depressão baseou-se no DSM-IV e a sua quantificação na escala de Hamilton. Foi diagnosticada depressão em cinco portadores de sela vazia (45 por cento) e dois indivíduos normais (20 por cento). Ambos os grupos apresentaram alto índice de história familiar de alcoolismo e outros fatores associados à depressão, externo ou internos. Entre os portadores de sela vazia e depressão, um paciente não apresentava doença endócrina, um apresentava diagnóstico de hipogonadismo e recebia reposição hormonal, um apresentava hiperprolactinemia e, outros dois, hipopituitarismo com reposição adequada, exceto quanto ao hormônio de crescimento, afastando as deficiências endócrinas como etiologia única do quadro psiquiátrico. A relação direta ou indireta das alterações selares com a presença de depressão não pode ser definitivamente estabelecida com base nesses achados, mas sugere-se esta possibilidade, relacionada a distúrbios em vias de neurotransmissores.

Empty sella in short children with and without hypothalamic-pituitary abnormalities.

A study was conducted on growth hormone (GH) response to oral clonidine (0.15 mg/m2), GH and cortisol responses to i.m. glucagon (0.1 mg/kg), and glucose response to an oral load of glucose (1.75 g/kg). Measurements were made on the circulating concentrations of free thyroxine (FT4), thyroid stimulating hormone (TSH) and different growth parameters and CT sellar images in 25 GH deficient children (Peak GH response to clonidine and glucagon < 7 ug/ml), 15 growth retarded children (Ht < 5th percentile for age and gender) with sickle cell disease (SCD) and GH deficiency, 30 randomly selected children with normal variant short stature (NVSS) (HtSDS 2SD below the mean for age and gender with normal GH response to stimulation (> 10 ug/ml) and 20 age-matched normal children were evaluated. Out of the 25 children with GH deficiency, five had multiple pituitary hormonal deficiency (GH < TSH and/or ACTH. deficiencies), and 20 had isolated GH deficiency. Empty sella, either complete or partial, was detected in 9 out the 20 children with isolated GH deficiency (45%), 4 out of the 5 children with multiple pituitary deficiency (80%), all the children with SCD and GH deficiency (100%), 3 out of the 30 children with NVSS (10%) and in none of the normal children. The insulin-like growth factor-I (IGF-I) concentrations were significantly lower in the two groups of children with GH deficiency compared to those with NVSS. The height standard deviation scores (HTSDS) were significantly lower and the annual growth velocity was slower in children with idiopathic GH deficiency and empty sella compared to those with NVSS and those with empty sella associated with SCD. The bone age delay (yr) did not differ among the 3 groups of children with short stature. All children with isolated GH deficiency associated with empty sella had normal body mass indices (BMI), while all the children with SCD and empty sella had BMI below the 5th percentile for the corresponding age and gender. None of the children had glucose intolerance. In conclusion, children with growth retardation and abnormal hypothalamic pituitary functions have high incidence of empty sella. However, empty sella is detected in considerable number (10%) of short children with normal hypothalamic pituitary function.

Sindrome da sela vazia: experiencia de 23 casos / Twenty-three cases of empty sella syndrome

Foram estudados 23 casos de sindrome da sela vazia (SSV) confirmada por tomografia computadorizada (TC), dos quais 14 primarios e 9 secundarios (oito pos-cirurgia e um devido a pseudotumor cerebral) No primeiro grupo predominou o sexo feminino (85 por cento) multiparidade (83 por cento) Obesidade (57 por cento) e hipertensao (21 por cento) Os sintomas mais encontrados foram cefaleia (92 por cento) alteracoes visuais (57 por cento) galactorreia (70 por cento e amenorreia (28 por cento). Ocorreram alteracao de campos visuais e de funcao hipofisaria em 57 por cento dos casos de SSV primaria. Ja entre os secundarios, a incidencia foi de 33 por cento e 55 por cento, respectivamente. Nao houve correlacao entre os sintomas visuais e as alteracoes de campos visuais. Houve uma correlacao apenas qualitativa das alteracoes endocrinas com as descritas na literatura. Foram enfatizadas a importancia de TC para o diagnostico correto da sindrome e a necessidade do acompanhamento periodico desses pacientes, dada a possibilidade de uma complicacao endocrina.

Imaging technology in the diagnosis of sellar disease

Radiographic computed tomography and magnetic resonance imaging are the procedures of choice in the diagnosis of patients with suspected pituitary gland abnormalities. Several cases are presented where the diagnostic value of such procedures in patients with diseases affecting the pituitary gland is demonstrated

Síndrome da sela vazia / Empty sell syndrome

Relata-se o caso de Síndrome da Sela Vazia em paciente com hipoestrogenismo, demonstrando-se as alteraçöes funcionais do eixo hipotálamo-hipófise-ovário encontrados. Diagnóstico e manuseio clínico säo discutidos à luz da literatura sobre o assunto

Alteraçöes endócrinas da síndrome da sela vazia / Endocrine alterations in empty sella syndrome

In this study we analyzed the clinical signs and symptoms and the major endocrine alterations detected in four patients with the empty sella syndrome, who were followed at the Tocogynecological Endocrinology out patient clinic of the University Hospital, Faculty of Medicine of Ribeirao Preto. As also reported in most studíes available in the litterature, all of our patients were hypertensive, obese and multiparae, and cephalea was their most common clinical complaint. Although hormonal levels were within normal limits, two patients presented marked hirsutism and required the use of specifíc medication.

Patología extraselar no tumoral con compromiso endocrino / Non tumoral extraselar pathology with endocrine involvement

Se revisaron las experiencias de la Sección de Neuroendocrinología de la Cátedra de Neurocirugía del Hospital de Clínicas de Buenos Aires, resaltando la importancia de las diferentes patologías extraselares que pueden causar trastornos endocrinológicos fácilmente confundibles con patología tumoral selar

Análisis clínicos y de la función hipofisiaria en pacientes con el síndrome de la silla turca vacía primaria / Analysis of clinical and hypophyseal function in patients with primary empty sella turcica syndrome

Se informan los hallazgos clínicos, hormonales y radiológicos en 22 casos de silla turca vacía primaria (STVP), en pacientes que tenían un promedio de edad de 44,5 años y además predominó en mujeres. El cuadro clínico consistió en cefalea (90,9%), síndrome quiasmático (18%) y fístula del líquido cefalorraquideo en 13,6 por ciento. Todos los pacientes tenían obesidad y prácticamente la mitad (45.4%) padecián hipertensión arterial. El diagnóstico se confirmó mediante una tomografia axial computada de cráneo usando como medio de contraste a la metrizamida. En todos los casos se encontró que la función hipofisaria, evaluada por la concentración de las hormonas circulantes, era normal. La presencia de fístula de líquido cefalorraquideo o de un síndrome quiasmático fueron las indicaciones para realizar cirugía transesfenoidal. Siete pacientes que fueron sometidos a cirugía, seis evolucionaron satisfactoriamente