Endocrine Abstracts

Background: Primary or idiopathic empty sella syndrome (ESS) is the herniation of the meninges through an incompetent diaphragma sellae into the sella turcica which pushes the pituitary gland aside so giving the appearance of an empty sella. Secondary ESS is caused by damage to pituitary tissue which results in an empty sella turcica. There is significant lack of agreement in the literature regarding the number of patients with empty sella syndrome (ESS) who suffer from pituitary dysfunction; some papers report that pituitary function is usually preserved while others state that it is not.

Aims: The aim of this study was to determine the proportion of patients with ESS who had endocrine abnormalities on presentation and to define radiological features to differentiate between primary and secondary ESS.

Methods: In this retrospective study, records of all patients diagnosed with an ‘empty sella turcica’ at since 1990 were reviewed. 26 patients satisfied these criteria and their MRI scans were re-evaluated blind by a neuroradiologist to confirm a diagnosis of primary or secondary ESS. Results of baseline endocrine testing and MRI scans were recorded. Information on demographics, presenting complaint and blood pressure were also collected.

Results: 65% (n=17) of patients diagnosed with ESS showed evidence of pituitary dysfunction. The most common endocrine abnormality was GH deficiency which affected 54% (n=14) followed by secondary hypothyroidism in 9 patients with low levels of TSH and T₄. Headache (39%) and fatigue (27%) were the most common presenting complaints.

Conclusion: ESS is a heterogeneous condition with varied, nonspecific symptoms and high rate of endocrine dysfunction. Endocrine function should be assessed in all patients with this diagnosis.