Empty Sella as a Clue to Idiopathic Intracranial Hypertension Presenting with Pulsatile Tinnitus and Progressive Hearing Loss
https://doi.org/10.15605/jafes.041.S1
- Author:
Jean Mun Cheah
1
;
Prasana Nair Gengadharan
2
;
Yuan Ye Beh
2
;
Shireene Ratna Vethakkan
1
Author Information
1. Endocrine Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya
2. Neurology Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya
- Publication Type:Journal Article
- MeSH:
Pseudotumor Cerebri;
Tinnitus;
Hearing Loss
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):88-89
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Empty sella (ES) is characterized by herniation of the
subarachnoid space into the sella turcica, leading to
pituitary flattening. Although often considered incidental,
ES is increasingly recognized as a radiological marker of
idiopathic intracranial hypertension (IIH) which classically
presents with headache and visual loss. Importantly, IIH
may also present with otolaryngological manifestations
such as pulsatile tinnitus, hearing loss, and vertigo.
Audiovestibular symptoms have been reported in up to
88.9% of patients with primary ES, with sensorineural
hearing loss being the most frequent, while pulsatile
tinnitus occurs in approximately 58% of IIH cases.
Case:A 51-year-old female presented with 3 months of progressively worsening headaches, rapid deterioration of
left-sided hearing, and a 20-kg weight gain over 1 year. Audiometry confirmed moderate left sensorineural hearing
loss. Examination revealed a normotensive female with a
body mass index of 35 kg/m² and diplopia on left upward
gaze without evidence of ophthalmoplegia. The rest of
the neurological examination was unremarkable. There
was no evidence of papilledema or Cushingoid features.
Repeat magnetic resonance imaging brain in 2025 showed
persistent partial ES and loss of the posterior pituitary bright
spot without an intracranial mass lesion or venous sinus
thrombosis. There was no biochemical evidence of hypopituitarism or Cushing’s syndrome. Autoimmune markers
were unremarkable. Lumbar puncture demonstrated
a mildly elevated opening pressure of 23 mmHg with
normal CSF composition. Based on the clinical and radiological findings, early IIH
was diagnosed. She was treated with acetazolamide, and
prescribed tirzepatide for weight reduction, resulting in
improvement in headache and tinnitus.
Conclusion:IIH can manifest with partial ES and audiovestibular
symptoms related to raised intracranial pressure. Early
recognition is important, and IIH should be suspected in
patients with pulsatile tinnitus or progressive sensorineural
hearing loss. Acetazolamide and weight management
remain the mainstay of treatment, with emerging evidence
supporting a potential role for glucagon-like peptide-1
receptor agonists in reducing intracranial pressure.
- Full text:2026080414422325299EP_A125.pdf
