12623 Hypopituitarism Secondary To Empty Sella Syndrome Post Motor Vehicle Accident

Abstract Disclosure: D. Fawcett: None. S. Ceballos: None. C. Livasky: None. Introduction: Empty sella is a pituitary disorder characterized by the herniation of the subarachnoid space within the sella turcica. It can be further classified as primary empty sella (PES), considered an idiopathic disease or secondary empty sella (SES) which may result after pituitary tumor treatment, spontaneous necrosis, infection, autoimmune disease or brain trauma. Case Description: 47-year-old female with no medical history, who presented to emergency due to a 2-week history of fatigue associated with persistent heart pounding sensation and intermittent holocranial headache. On admission, the patient had sinus tachycardia with a normal blood pressure, and a non-focal neurologic exam. Her initial labs were significant for elevated lactic acid and low TSH. Initially a hyperthyroid etiology was considered, however, thyroid panel obtained on admission showed low T4 level. On further interrogation patient recalled a recent motor vehicle accident (MVA) a month prior to symptoms developing, without medical evaluation at the time. Brain MRI was completed as part of a central etiology work up demonstrating an empty sella with enlargement of the sella turcica measuring 1.6 cm. No contrast enhancing lesions were seen. Endocrinologic work up was consistent with a secondary adrenal insufficiency. Patient was discharged with hormonal thyroid and hydrocortisone supplementation. Discussion: Empty sella is a pituitary disorder in which a herniation of the subarachnoid space within the sella turcica occurs. There are two types: Primary empty sella (PES) which is considered idiopathic and is seen in patients with no history of previous pituitary pathology, and Secondary empty sella (SES) which may result after pituitary tumor treatment such as surgery or radiation, spontaneous necrosis, infection, autoimmune disease or brain trauma. The patient we presented did not have medical history consistent with autoimmune diseases or prior procedures. However, she did report an MVA with head trauma, that did not receive medical attention with subsequent development of headache and rest of previously described symptoms, highly concerning for a possible traumatic etiology. A high level of suspicion is required for diagnosis, particularly in patients with unspecific symptoms in order to improve patient’s prognosis. Presentation: 6/1/2024