Adenohipopituitarismo de rápida instalación, sin correlato imagenológico / Acute onset adenohypopituitarism without an image diagnosis

ABSTRACT

We report two cases of acute onset of adenohypopituitarism without a sellar MRI finding. The first case is a postmenopause woman complaining of fatigue, weakness, nausea, vomiting, diarrhea and mild weight loss. She was extensively studied with upper gastrointestinal endoscopy, colonoscopy and abdominal CT. An incidental possible pituitary enlargement on a Brain CT opened a pituitary function study, revealing adenohypopituitarism. The sellar MRI was perfectly normal, without anatomical explanation. The second case is a postmenopause woman complaining of fatigue and weakness, who had an episode of syncope and concomitant hyponatremia. Her study revealed adenohypopituitarism and a primary empty sella image in the MRI. The clinical problem of adenohypopituitarism without an image diagnosis brings the ethical dilemma to make a “blind” transsphenoidal biopsy or just treat them without a certain diagnosis. Patients with Empty Sella in the MRI show frequently normal pituitary function and it is not considered as a cause of so extensive hypopituitarism. Sometimes the clinical and image evolution can suggest the etiology and require of histological sample, so it is rational to keep an active surveillance and repeat the functional tests and Sellar MRI within the follow up...