Epilepsy and Bipolar Disorder Associated with Empty Sella Syndrome: A Case Report

Background/Aims: Empty sella syndrome (ESS) is a condition characterized by a herniation of the subarachnoid space into the sella turcica, often leading to partial or complete flattening of the pituitary gland. ESS is frequently associated with neurological and hormonal abnormalities, and its diagnosis is commonly incidental during evaluations for pituitary dysfunction or increased intracranial pressure. Despite its prevalence, the clinical significance of ESS and its potential relationship with psychiatric and neurological disorders remain poorly understood. Methods: We present the case of a 40-year-old male patient with a history of bipolar affective disorder and epilepsy. The patient experienced recurrent neuropsychiatric symptoms, including manic and depressive episodes, suicidal ideation, and attempts. Following a deterioration in his psychiatric state, he was hospitalized, where further complications, including epileptic seizures and status epilepticus triggered by an overdose of quetiapine, arose. Results: Comprehensive biochemical analyses revealed normal endocrine function, including growth hormone (GH), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Neuroimaging studies, including magnetic resonance imaging (MRI), computed tomography (CT), and electroencephalography (EEG), identified primary ESS, which had not been previously recognized in this patient. Conclusion: This case underscores the potential but controversial link between bipolar affective disorder, epilepsy, and ESS. It highlights the need for thorough neurological and endocrine evaluations in patients presenting with complex neuropsychiatric symptoms. Further investigation into the mechanisms underlying these comorbidities could provide valuable insights into the pathophysiology of ESS and its clinical implications.