Hypopituitarism is most commonly caused by pituitary or parasellar tumors, while vascular lesions such as intracranial aneurysms are exceedingly rare etiologies. We report a unique case of a 42-year-old woman with a long-standing history of hypothyroidism who presented with generalized edema, hypotension, amenorrhea, and recurrent hypoglycemia. Biochemical assessment revealed panhypopituitarism-secondary hypothyroidism [free thyroxine (FT4) <0.88 pmol/L, thyroid-stimulating hormone (TSH) 3.36 µIU/mL] and secondary adrenal insufficiency, with extremely low serum cortisol (<0.16 µg/dL) and adrenocorticotropic hormone (ACTH) 9 pg/mL. Gonadotropins were also reduced [luteinizing hormone (LH) 1.49 mIU/mL, follicle-stimulating hormone (FSH) 5.12 mIU/mL]. Magnetic resonance imaging (MRI) of the brain demonstrated an empty sella with a left supraclinoid internal carotid artery (ICA) saccular aneurysm extending into the suprasellar region. Digital subtraction angiography confirmed the diagnosis, and the patient underwent successful endovascular coiling. Following the intervention, her electrolyte abnormalities resolved, and she remained stable on hydrocortisone and thyroxine supplementation. This case highlights the importance of considering ICA aneurysm in the differential diagnosis of hypopituitarism, as its presentation can mimic pituitary adenoma. In contrast to prior reports where visual disturbances predominated, this case presents isolated endocrine dysfunction without visual or neurological symptoms. Additionally, the coexistence of an empty sella and supraclinoid ICA aneurysm-induced panhypopituitarism is exceptionally rare. Early recognition with neuroimaging and timely intervention are crucial to prevent life-threatening endocrine crises and neurological complications.

Sheehan's syndrome (SS) is a rare endocrine disorder caused by ischemic necrosis of the anterior pituitary gland secondary to massive postpartum hemorrhage (PPH) and shock. It commonly leads to multiple hormonal deficiencies, such as adrenal insufficiency, hypothyroidism, and hypopituitarism. Affected individuals may present with signs and symptoms including weight gain or loss, cold intolerance, hair loss, menstrual irregularities, and hypotension. Diagnosis is often delayed due to its nonspecific presentation and overlap with conditions like postpartum depression and chronic fatigue syndrome. This case report highlights the clinical presentation, management challenges, and complications associated with the delayed diagnosis of SS. A 35-year-old female was diagnosed with SS in 2016, at the age of 26, following severe PPH and hemorrhagic shock after a vaginal delivery in 2013. Initially, she experienced failure to lactate, followed by amenorrhea, frontal balding, weight loss, hypotension, chronic fatigue, mood swings, and polyuria. For several years, her symptoms were misattributed to postpartum depression, resulting in delayed diagnosis and treatment. A comprehensive endocrine evaluation revealed secondary adrenal insufficiency, central hypothyroidism, and hypogonadotropic hypogonadism, as evidenced by low levels of ACTH, cortisol, TSH, free T4, FSH, LH, and prolactin. Magnetic resonance imaging (MRI) confirmed partial empty sella, supporting the diagnosis of SS. She was started on lifelong hormone replacement therapy (HRT) consisting of hydrocortisone, levothyroxine, and estrogen. She remained highly sensitive to hormone doses, requiring frequent adjustments every other month. Despite modifications, she continued to experience persistent symptoms, including fatigue, hair loss, extreme mood swings, night sweats, and gastrointestinal symptoms such as abdominal discomfort, epigastric pain (worsened on an empty stomach), nausea, vomiting, bloating, and passage of blood in stool, likely related to long-term medication use. Pregnancy was later achieved through ovulation induction using human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG). She developed an adrenal crisis during pregnancy, which was managed through hydrocortisone dose modification. The immediate postpartum period was uneventful under treatment, but she required close endocrine follow-up for ongoing metabolic and reproductive concerns. This case highlights the typical clinical presentation of SS in a postpartum patient, including lactation failure, fatigue, and amenorrhea, which can facilitate early diagnosis of this serious and potentially life-threatening condition. Delayed diagnosis is often linked to prolonged morbidity, affecting both quality of life and fertility. Lifelong HRT, regular endocrinological monitoring, and individualized treatment plans are essential for managing endocrine dysfunction, osteoporosis risk, and cardiovascular complications. Awareness, early screening, and multidisciplinary collaboration among endocrinologists, obstetricians, and reproductive specialists are pivotal in improving long-term outcomes and reducing diagnostic delays.

Sheehan syndrome is a rare condition of pituitary necrosis following postpartum hemorrhage, hypovolemia, and/or associated shock, presenting with lactation failure and acute hypopituitarism immediately postpartum; chronic hypopituitarism can manifest months to years later. We present a patient with chronic Sheehan syndrome with isolated growth hormone (GH) deficiency presenting with secondary infertility in whom GH replacement led to natural conception, demonstrating reversibility of infertility. A 38-year-old female patient was referred for secondary infertility on a background of postpartum hemorrhage and inability to breastfeed postpartum 4 years earlier. During workup for secondary infertility, her investigations revealed an isolated GH deficiency, confirmed on a glucagon stimulation test, and a partially empty sella and a thin, 1.6-mm pituitary gland on magnetic resonance imaging, supportive of chronic Sheehan syndrome. Other fertility investigations were unremarkable. Before GH replacement, the patient had 1 unsuccessful cycle of in vitro fertilization. After 2.5 months of GH replacement, the patient achieved natural conception. Individuals with a history of postpartum hemorrhage, agalactorrhea, and symptoms potentially indicative of hypopituitarism should be investigated for chronic Sheehan syndrome. In pituitary pathology, GH deficiency should be considered as a potential contributor to infertility, which can be treated and potentially reversed with GH replacement.

Primary empty sella (PES) consists of herniation of the suprasellar subarachnoid space within the sella turcica in patients with no history of sellar pathology. Diagnosis is mostly made incidentally. Describe the characteristics of patients with PES. Patients with PES from 6 Argentine centers specialized in Neuroendocrinology in Buenos Aires diagnosed between 1997-2021 were included. Diagnosis was based in sellar magnetic resonance, pituitary functional evaluation by baseline hormonal measurement and visual function assessed by neuro-ophthalmological evaluation and campimetry. Sixty-three patients with a mean age of 52.3 ± 13.2 years and a predominance of female gender (79%, 4:1 ratio) were included. The average BMI was 32.7 ± 8.13 kg/m2 and 68% were overweight or obese. HTA was also found in 59%. Among women, the parity frequency was 78%: 92% had multiple pregnancies. The diagnosis was incidental in 22%. In symptomatic patients (n= 49), the reasons for consultation were headache in 61%, symptoms of endocrine dysfunction in 51% and visual disturbances in 33%: 43% of the patients presented multiple symptoms. MRI showed partial PES in 63% and total PES in 37% of the patients. In the biochemical evaluation, hypopituitarism was observed in 46%. Although the diagnosis of PES can be made incidentally, in our series most of the patients presented symptoms. Most of them were multiparous women, obese and hypertensive patients. Biochemical evaluation should be carried out to investigate isolated or multiple pituitary deficits in order to indicate the corresponding replacement treatment. La silla turca vacía primaria (STVP) consiste en la herniación del espacio subaracnoideo supraselar dentro de la silla turca en pacientes sin antecedentes de patología selar. El diagnóstico se realiza mayoritariamente de forma incidental. Objetivos: Describir las características de pacientes con STVP. Pacientes de 6 centros argentinos especializados en Neuroendocrinología con STVP entre 1997-2021. El diagnóstico fue realizado mediante resonancia magnética selar (RM), la evaluación funcional hipofisaria por medición hormonal basal y la función visual mediante evaluación neuro-oftalmológica y campimetría. Se incluyeron 63 pacientes con una edad promedio de 52.3± 13.2 años y predominio femenino (79%; 4:1). El IMC promedio fue de 32.7 ± 8.13 kg/m2 y un 68% presentaron sobrepeso u obesidad. El 59% presentaba HTA. Entre las mujeres, la frecuencia de paridad fue 78 %: 92% tuvieron embarazos múltiples. El diagnóstico fue incidental en 22% de los pacientes. En los pacientes sintomáticos (n= 49), los motivos de consulta fueron cefalea en el 61%, síntomas de disfunción endocrina en 51% y alteraciones visuales 33%. El 43% presentó más de un síntoma. La RM evidenció STV parcial en 63% y STV total en 37% de los pacientes. En el 46% se observó hipopituitarismo. En nuestra serie la mayoría de los pacientes presentaron sintomatología. Se observó un claro predominio en mujeres multíparas, y en pacientes obesos e hipertensos. Debe instrumentarse la evaluación bioquímica para pesquisar el déficit pituitario aislado o múltiple e indicar el correspondiente tratamiento sustitutivo.

Empty Sella Syndrome (ESS) is characterized by a herniation of cerebrospinal fluid into the pituitary fossa, frequently causing pituitary dysfunction. Although ESS is generally asymptomatic, it can lead to progressive hormonal deficiencies. Long-term studies of pituitary function in patients with ESS are lacking. This study aimed to evaluate pituitary function in ESS patients, monitor the progression of hormone deficiencies, and explore the impact of gender, age, and body mass index (BMI). This is a descriptive and analytical study involving 41 patients diagnosed with ESS and treated at our university hospital between 2014 and 2024. All patients underwent MRI and endocrine testing for cortisol, thyrotropin, free thyroxine, prolactin, growth hormone, gonadal hormones, and testosterone. The median duration of follow-up was 5 years, with a range of 6 months to 10 years. Data was collected and analyzed using SPSS version 21. At diagnosis, 82.9% of patients had at least one pituitary hormone deficiency, primarily in the adrenal, gonadal, and growth hormone axes. Women were more likely to develop gonadal dysfunction (34.1%) than men (21.9%). A positive correlation between age and adrenal/gonadal insufficiency was observed. Additionally, a significant association was found between higher BMI and gonadal insufficiency, highlighting the role of obesity in exacerbating pituitary dysfunction. ESS is commonly linked to pituitary dysfunction, particularly in the adrenal and gonadal axes. Gender, age, and BMI influence the development and progression of hormonal deficiencies, underscoring the need for regular endocrine evaluation and long-term follow-up in these patients.