Increased intracranial pressure due to chronic weight lifting exercises as a hypothesis of partial empty sella syndrome in an elite athlete

Empty sella syndromes are barely known to occur in patients with elevated intracranial pressure. Chronic weightlifting workout may increase their intracranial pressure, leading to the atrophy of pituitary gland. Here we report the case of an elite endurance athlete with heavy lifting performances, without objective use of exogenous hormones, in whom was diagnosed a partial empty sella following an erectile dysfunction. A 54-year-old endurance athlete presented with a recent progressive erectile problem. The patient has been in competitive endurance sports for the past 25 years, with a moderate weightlifting workout of 45 to 60 min per day, 6 days per week. The patient's other complaints were a muscle fatigue attested by a global amyotrophy on physical exam, without major deficits, with a slightly decreased libido. Hormonal assessment showed hypogonadotropic hypogonadism with a decreased FSH and LH levels and low testosterone levels. Other pituitary's functions were normal. A pituitary MRI revealed a partial empty sella syndrome, without adenoma or supra sellar anomalies. The etiology retained of this partial empty sella was the elevated intracranial pressure secondary to the intensive weightlifting workout that might increase intracranial pressure, leading to the atrophy of pituitary gland.