Growth hormone and prolactin production in a patient with partial primary empty sella: a case report

Abstract

Introduction: The empty sella syndrome is a neuroradiological diagnosis that shows pituitary gland reduction or flattening, with a prevalence of around 8% to 35% in general population. Objective: We report a case in which there is an association between partial primary empty sella syndrome and high levels of growth hormone and prolactin. Methods: A 67-year-old man, from Coronel Mota Hospital, Boa Vista / RR, with no specific complaints, was referred to the Endocrinology ambulatory to investigate a modification in sella area. After anamnesis and physical examination, acromegaly research began. Pituitary hormones and magnetic resonance imaging of the sella turcica with contrast were requested. Results: General physical examination revealed acromegalic face, nasal enlargement, macroglossia and frontal cutis verticis gyrata. Radiological examination showed partial empty sella. Laboratory evaluation confirmed the clinical suspicion of acromegaly and revealed hyperprolactinemia presence. It was decided to treat the patient with cabergoline 1.5 mg / week and to refer him to a center specialized in neuroendocrinology. Conclusion: This report shows a case of partial primary empty sella and co-production of growth hormone and prolactin, making this association interesting, since somatotropinomas are mostly (80%) macroadenomas. In addition, the underdiagnosis of acromegaly is highlighted, since the symptoms are nonspecific and insidious, leading to high morbidity and mortality and reduction of the affected patients life expectancy.