Empty sella and reversible central adrenal insufficiency in treated primary hypothyroidism

Introduction: Primary hypothyroidism can be complicated by pituitary-related sequelae. Along with a few other reports, we documented pituitary dysfunction with empty sella in primary hypothyroidism; however, the spontaneous reversibility of the hypopituitarism is rarely reported. We aimed to describe a rare complication of primary hypothyroidism and to emphasize the importance of monitoring such complications. Case Report: We report a previously healthy 59-year-old man who presented four years earlier with weight gain of several months duration. The investigations revealed primary hypothyroidism with thyroxine 5.2 pmol/L (7.8–16) and thyroid stimulating hormone >100 uIU/L (0.27–4.2). He responded well to the thyroxine replacement as he became asymptomatic with normalization of thyroid stimulating hormone (TSH). After a few years, the patient presented with lethargy and postural hypotension despite euthyroidism. The basal and stimulated cortisol levels were low 73 (185–624) and 185 nmol/L respectively, while the adrenocorticotrophic hormone was inappropriately normal at 16.1 pg/mL (10.00–46.00). All the other pituitary hormones were normal. Magnetic resonance imaging showed partial empty sella. The patient preferred conservative management. Subsequently, he showed progressive clinical and hormonal improvement. As scarcely reported in the literature, primary hypothyroidism can be complicated by the development of empty sella, which can further develop pituitary endocrinopathies. Central adrenal insufficiency has been reported more often than other empty sella-related pituitary endocrinopathies, which might need long-term therapy. Conclusion: We documented that empty sella and the associated hypopituitarism might complicate the primary hypothyroidism. This report encourages monitoring, and managing these complications in longer-term follow-up.