Empty sella syndrome impact on pregnancy .

CASE REPORT

 

Objective :

Demonstration of a rare case of empty sella syndrome and its impacts on pregnancy.

 

Case Report :

A 42-year-old Sudanese lady with a history of two normal delivery and two miscarriage in the first

trimester, hypothyroidism on 100mcg of thyroxine and hyperprolactinemia previously on cabergolin,

presented to our general obstetric clinic in early pregnancy.

On reviewing her history of chronic recurrent headache, nipple discharge, irregular period and history

of pregnancy induced hypertension in previous pregnancies treated with medication.

On presentation to the general obstetric clinic she was around 5 weeks of gestation and a follow-up

scan was arranged after 2 weeks which showed an intrauterine gestational sac corresponding to 6

weeks with no fetal cardiac activity. A follow up appointment was arranged but the patient presented

after 6 days to the emergency department with vaginal bleeding. On examination her cervix was open

with no visible retained products and ultrasound scan confirmed the diagnosis of incomplete

miscarriage. She was later admitted for medical management with misoprostol 400 mg and

successfully passed the retained products of conception. She was discharged and was reviewed by

internal medicine 2 months post miscarriage with complaints of intense headache not relieved with

paracetamol, hyperprolactinemia of 1,752 mili/IU/L, breast fullness, and lactorrhea. She had a

mammogram showing bilateral duct ectasia with no suspicious findings of malignancy. MRI of the

brain was requested due to recurrent intense headache and lactorrhea which showed a large partial

empty sella and enhancing residual anterior pituitary gland tissue present with no gross evidence of

pituitary microadenoma. She is following with internal medicine, currently, she is not on dopamine

agonists.

 

 

Discussion :

Empty sella syndrome (ESS) is a radiological

diagnosis on MRI of the characteristic of (1)

herniation of the diaphragm sellae (2) the

presence of cerebrospinal fluid in the sella

turcica (3) flattening of the pituitary gland.

There are primary and secondary ESS. ESS is

common in middle aged women and the

estimated range of 2% -20% prevelance. The

pituitary function is usually normal, only 10%

of the patients presented with mild

hyperprolactinemia. It is associated with

hypertension, hypothyroidism and obesity .

Women might suffer from amenorrhea,

galactorrhoea and infertility. Women with

hyperprolactinemia might need to induce

ovulation with bromocriptine to achieve

pregnancy.

 

Conclusion: 

Importance of preconception visit in hyperprolactinemia women with a history of recurrent miscarriage and early treatment to prevent future miscarriage.