Case report of partial empty sella syndrome: A challenging cocktail for the anesthesiologist

Abstract

Background: Eventhough panhypopituitarism is a rare endocrine system disease, the clinical manifestation can vary from subclinical to life threatening myxoedema coma. It could be due to either primary pituitary dysfunction/stalk dysfunction/hypothalamic dysfunction.A 32 year old young female who presented with bilateral hip joint pain was diagnosed to have bilateral avascular necrosis of femoral head. On ellicting a detailed clinical history, she underwent treatment for infertility for 7 long years which comprised of multiple ovulation induction agents and finally conceived following in utero insemination. Although the gestational and peripartum period were uneventful, she had agalactorrhea, a warning sign of impending hormonal dysfunction which didn’t seek much attention. Five years down the lane, on evaluation for dyslipidemia, she was found to have hypothyroidism, hypocalcemia, low serum calcitriol levels. A detailed brain imaging studies showed partially emptysella with small remnant pituitary tissue and was started on treatment as a case of panhypopituitarism.