An unconscious woman of short stature (141 cm) was admitted to our hospital in March, 1994. She had
hyponatremia (120 mEq/l) and had experienced massive
bleeding during delivery. No increment of either plasma
ACTH or
cortisol levels was observed after
insulin-induced
hypoglycemia. However, urinary 17OHCS levels gradually increased after repeated
intramuscular injections of
ACTH. Plasma free T3 and free T4 levels were low. Neither plasma TSH nor
prolactin (PRL) levels increased after an
intravenous injection of TRH. Basal plasma LH, FSH and
growth hormone (GH) levels were low and there were no observable responses to any of the stimulation tests. A magnetic resonance image (MRI) of her pituitary gland showed an empty sella. These results showed that she had a
panhypopituitarism with primary empty sella. Replacement
therapy with
glucocorticoid was started and serum
sodium levels normalized immediately.
Levothyroxine was also administered. The possibility of
pituitary dwarfism during her youth and a gradual postpartum reduction of other
pituitary hormones may have caused an impairment of the hypothalamo-pituitary-adrenal axis.