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A 39-year-old female presented with progressive fatigue, extreme tiredness, muscle
pain, giddiness and shortness of breath for six months. On further questioning she
reported lack of menses for 19 years, since her last pregnancy. She reported that
she had a home delivery 19 years ago with post partum haemorrhage that required hospitalisation
and three units of blood transfusion. Clinical examination showed pallor, with no
axillary (Fig. 1A) and pubic hair. Biochemical evaluation showed the presence of hypoprolactinaemia
(Prolactin - 0.8 ng/ml; NR 2.8–29.2), secondary hypocortisolism (Cortisol - 0.63 mcg/dl;
RR 8.7–22.4; ACTH – 45 pg/ml; RR <46), secondary hypothyroidism with a low FT4 (FT4
- 0.4 ng/dL; RR 0.89–1.76), and low FT3 (FT3 - 0.9 pg/mL; RR 2.3–4.2) and an inappropriately
normal thyroid-stimulating hormone (TSH) [2.59 mU/L; (RR 0.30–5.5)]. She also had
central hypogonadism with a low oestradiol (<5 pg/mL; RR 12.5–166), an inappropriately
low luteinizing hormone (LH) [1.0 mU/mL; (RR 1.9–12.5)] and follicle-stimulating hormone
(FSH) [0.21 mU/ml; (RR 2·5–10·2)]. An MRI pituitary (Fig. 1B) revealed a low volume pituitary with an empty sella (arrow).
Fig. 1Panel A – Right axillary area showing the absence of axillary hair; Panel B – MRI sagittal section showing an empty sella.
