Adrenal Insufficiency due to Total Primary Empty Sella Syndrome

Abstract

A 64-year-old woman was transported suffering from persistent lower abdominal pain, vomiting, and low-grade fever.
Magnetic resonance imaging revealed an empty sella (ES) and hormone tests revealed a disappearance of diurnal variation
of cortisol, low cortisol and adrenocorticotropic hormone (ACTH) secretion especially in the morning, and poor ACTHcortisol
axis reaction, as well as normal hypothalamus-pituitary gland-thyroid or adrenal gland axis hormone reaction.
The cause of ES remained unclear; however, based on a diagnosis as adrenal insufficiency due to inappropriate ACTH
secretion caused by total primary ES syndrome, we started hydrocortisone (15 mg/day). Afterwards, she immediately
became symptom-free and was discharged.