Journal of Rawalpindi Medical College | 2026
Authors: Hafeez N.; Gull N.; Gull A.; Niazi F.A.K.
DOI: 10.37939/jrmc.v30i1.2766
Journal: Journal of Rawalpindi Medical College
Year: 2026
Publisher: Rawalpindi Medical University
Document Type: Article
Open Access: All Open Access; Gold Open Access
Cited by: 0
Background: Benign idiopathic intracranial hypertension (BIIH) is characterised by increased intracranial pressure without identifiable intracranial pathology and commonly presents with headache. However, atypical presentations without headache may delay the diagnosis and increase the risk of irreversible visual loss. Empty sella syndrome is a radiological finding that may be associated with increased intracranial pressure and pituitary dysfunction, although hormonal abnormalities are often under-recognized. Case Presentation: We report the case of a 38-year-old woman who was obese and presented with progressive visual impairment and asymmetric bilateral papilledema in the absence of headache, nausea, or vomiting. Visual acuity was preserved in the right eye but markedly reduced in the left eye. Neuroimaging revealed an empty sella with flattening of the pituitary gland, and cerebrospinal fluid opening pressure was markedly elevated. Hormonal evaluation demonstrated isolated gonadotropin insufficiency with low follicle-stimulating hormone levels. The patient was diagnosed with benign idiopathic intracranial hypertension associated with empty sella syndrome. Management included therapeutic lumbar puncture, oral acetazolamide, and combined oestrogen–progesterone hormone replacement therapy, which was initiated after an endocrinology consultation. Gradual improvement in visual function was observed over a six-month follow-up period. Conclusion: This case highlights an atypical, headache-free presentation of benign idiopathic intracranial hypertension associated with empty sella syndrome and gonadotropin insufficiency. It underscores the importance of considering BIIH in patients presenting primarily with visual symptoms and emphasises the role of comprehensive hormonal evaluation and multidisciplinary management in optimising visual outcomes. © 2026 Hafeez et al.
Empty Sella Syndrome; Gonadotropin Deficiency; Idiopathic Intracranial Hypertension; Papilledema; Visual Impairment