Easy Fatigability! What is the Cause?

A 50-year-old lady with a senile look, presented with a 6-month history of weakness, lethargy, and giddiness. She also said that during the course of a year, she lost 4 kg body weight. Her only child birth was 24 years ago. On further questioning, she gave a history of an episode of unconsciousness and lactational failure after childbirth. She did have a few menstrual cycles postdelivery and had primary failure of menstruation at the age of 27. On investigations, her FT4 was low, but thyroid stimulating hormone (sTSH) was inappropriately normal. She had low cortisol and low adrenocorticotropic hormone stimulated cortisol. An inappropriately normal follicle-stimulating hormone and low prolactin. Magnetic resonance imaging revealed partial empty sella syndrome [Figure 1]. She also had anemia and dyslipidemia, which improved on follow-up without any specific medical intervention [Table 1].Figure 1: Coronal T1-weighted magnetic resonance imaging brain scan showing features of partial empty sella syndrome. The sella turcica appears partially filled with cerebrospinal fluid, with a flattened pituitary gland against the sellar floor and residual pituitary tissue visible along the marginsTable 1: Serial investigation of the patient from pre to 16-week posttreatmentShe was treated with levothyroxine and hydrocortisone. Informed consent for the use of images and test reports was obtained from the patient. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.