EMPTY SELLA SYNDROME IN A PATIENT WITH TENOFOVIR-INDUCED FANCONI'S SYNDROME

DIAGNOSIS BY SERENDIPITY

Abstract

INTRODUCTION
Empty sella syndrome (ESS) is generally asymptomatic, incidentally detected, and usually requires no specific treatment. However, hypopituitarism is present in some ESS patients.

CASE
A 63-year-old female asymptomatic patient with HIV on long-term antiretroviral treatment presented with progressive weight loss of 22 kg over 18 months prior to hospitalization from tenofovir-induced Fanconi’s syndrome. Prior to hospitalization, extensive evaluation was carried out and did not yield any identifiable causes of weight loss. After hospitalization, polyuria and normoglycemic glucosuria from Fanconi’s syndrome were identified but subsequently, a diagnosis of panhypopituitarism was made after hormonal evaluation studies. An MRI of pituitary gland revealed thinned pituitary gland with normal size of sella. She denied history of postpartum hemorrhage and had regular menstruation until menopause. Partial ESS with hypopituitarism was finally diagnosed and oral prednisolone with thyroid hormone were given. She gradually regained weight and well-being after tenofovir discontinuation and hormone replacement. Full normalization of proximal tubulopathy markers was obtained within two months of tenofovir discontinuation.

CONCLUSION
Antiretroviral therapy helps people with HIV live longer but sometimes these medications can cause late side effects as presented in our patient. Apart from a straightforward diagnosis, patients can have different diseases to explain their symptoms. Physicians should consider the possibility of adrenal insufficiency in the broad differential diagnoses of unexplained weight loss.