Diagnosis of Empty Sella Syndrome

Empty Sella Syndrome Diagnosis: Book Excerpts

• Differential Diagnosis - Amenorrhea – Secondary
• Diagnosis - Secondary polycythemia
• Differential Overview - Secondary Amenorrhea
• Diagnosis - Polycythemia, secondary

Diagnostic Tests for Empty Sella Syndrome: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Empty Sella Syndrome.

Amenorrhea – Secondary: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Pregnancy
  –Most common cause
• Anovulatory cycles
  –Common during first few years after menarche
  • Hyperandrogenism
    –Polycystic ovary syndrome: Problems with fertility are common, LH/FSH ratio is greater than 2.5/1
    –Some adrenal tumors
    –Congenital adrenal hyperplasia
    –Exposure to anabolic steroids
  • Major illness or stress
  • Large changes in weight
    –Anorexia nervosa
  • Hypothyroidism
  • Prolactinoma
  • Other causes of hyperprolactinemia
    –Marijuana
    –Opioids
    –Antidepressants
    –Phenothiazines
  • Hypothalamic-pituitary failure
    –Pituitary tumor
    –Sheehan syndrome
    –Cranial irradiation
  • Ovarian failure
    –Autoimmune destruction
    –Infarction due to gonadal torsion
    –Chemotherapy or radiation
    –Idiopathic
  • Oral contraceptives
    –May delay return to regular menses
  • Cushing syndrome
  • Uterine synechiae (Asherman syndrome)
  • Chiari-Frommel syndrome

  Workup and Diagnosis

  • History
    –Major illness, thyroid disease, malnutrition, eating disorder, excessive weight gain or loss
    –Intensive exercise
    –Previous uterine procedures
    –Prior pregnancy with failure of lactation
    –Sexual activity
  • Review of systems
    –Virilization (e.g. facial hair, acne)
    –Symptoms of hypothyroidism
    –Headache or visual changes (for intracranial tumors)
    –Breast discharge, decreased breast size
  • Physical exam
    –Height, weight, acne, facial hair, acanthosis nigricans, striae, galactorrhea
    –Visual fields and optic discs (for intracranial tumors)
    –Palpate thyroid for goiter
    –Underestrogenized vaginal mucosa is reddish, thin, and atrophic
    • Labs
      –Pregnancy test
      –Thyroid function tests, FSH, LH, estradiol, prolactin, total and free testosterone, dehydroepiandrostenedione sulfate (DHEA-s), 17-hydroxyprogesterone
      –3-day progesterone “challenge” that induces withdrawal bleeding suggests adequate estrogen
    • MRI of the brain/pituitary to evaluate for pituitary pathology

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Secondary polycythemia: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Confirming diagnosis  Laboratory values for secondary polycythemia include increased RBC mass (increased hematocrit, Hb levels, and mean corpuscular volume and mean corpuscular Hb values) and urinary erythropoietin and blood histamine levels, with decreased or normal arterial oxygen saturation. Bone marrow biopsies reveal hyperplasia confined to the erythroid series.

Unlike polycythemia vera, secondary polycythemia isn’t associated with leukocytosis or thrombocytosis.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Secondary Amenorrhea: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Pregnancy

❑ Menopause

❑ Functional hypothalamic amenorrhea

❑ Drugs

❑ Anorexia nervosa

❑ Post-contraceptive

❑ Endometrial scarring

❑ Endocrinopathy

❑ Hyperprolactinemia

❑ Premature ovarian failure

❑ Polycystic ovary syndrome

❑ Chromophobe adenoma

❑ Ovarian tumors

❑ Panhypopituitarism

❑ Müllerian dysgenesis

Diagnostic Approach

Evaluation should always begin with a history and a urine hCG for pregnancy. On physical examination, attention should be paid to darkening of the areola, and evidence of estrogenization of the vagina.

Estrogen sufficiency can be assessed by observing a fern-like pattern of cervical mucous on a slide or by giving medroxyprogesterone for 5 days and looking for withdrawal bleeding. Bleeding suggests suppression of LH surge as seen in functional amenorrhea or polycystic ovary syndrome.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Polycythemia, secondary: Diagnosis
(Handbook of Diseases)

Laboratory findings for secondary polycythemia include increased RBC mass (increased hematocrit, hemoglobin level, mean corpuscular volume, and mean corpuscular Hb level), urinary erythropoietin, and blood histamine, with decreased or normal arterial oxygen saturation.

Bone marrow biopsies reveal hyperplasia confined to the erythroid series. Unlike polycythemia vera, secondary polycythemia isn’t associated with leukocytosis or thrombocytosis.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

 » Next page: Signs of Empty Sella Syndrome

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