Publication:

Silent sella, silent glands: a case of secondary adrenal insufficiency in partial empty sella

Empty sella syndrome (ESS) is a rare cause of hypopituitarism and may lead to secondary adrenal insufficiency (SAI). Atypical presentations without classic signs such as hypotension or electrolyte imbalance can delay diagnosis. We report a 41-year-old woman presenting with recurrent generalized tonic-clonic seizures and persistent hypoglycemia unresponsive to dextrose. Her medical history included anemia, alopecia, prior bariatric surgery, and bilateral oophorectomy. Laboratory tests revealed low adrenocorticotropic hormone (ACTH) levels with normal thyroid function. Brain magnetic resonance imaging (MRI) showed partial empty sella without mass lesions, indicating pituitary dysfunction and central adrenal insufficiency. The patient received intravenous hydrocortisone and glucose, leading to rapid resolution of seizures and hypoglycemia. She was transitioned to oral corticosteroid therapy and discharged with endocrine follow-up. No further hypoglycemic or seizure episodes occurred during follow-up. This case highlights the importance of considering central adrenal insufficiency in adults with unexplained seizures and refractory hypoglycemia. Partial empty sella may cause subtle pituitary hormone deficiencies that are easily overlooked. Early recognition and prompt glucocorticoid therapy are essential to prevent adrenal crisis and improve outcomes.