Endocrine Abstracts

Background: Primary empty sella is an anatomical term defining the herniation of subarachnoid space within the sella turcica without an underlying factor such as pituitary tumor, surgery, irradiation or trauma.

Patients and methods: We retrospectively evaluated clinical, hormonal and radiological data of the patients with primary empty sella syndrome followed in our institution between 2001 and 2012.

Results: Ninety-four patients (80 (85.1%) females) were included in the study. The mean age of the patients at diagnosis was 50.3±15 years (15–85). Fatigue and headache were the most common presenting symptoms (47.9 and 42.6% respectively). Menstrual irregularity in women (25%) and impotence in men (35%) were the most common sex specific symptoms. In addition galactorrhea, visual abnormalities, loss of libido were also recorded at a lesser extent. Of the risk factors of primary empty sella, multiparity was detected in 80% of the female patients and hypertension in 29.8%, weight excess in 44.7%, autoimmune thyroid disorder in 12.8% of the whole study group. Patients were evaluated for pituitary function with basal hormone levels and dynamic testing when necessary At least one pituitary hormone deficiency was found in 67% of cases. Growth hormone deficiency was the most common (54.3%) hormonal abnormality. Secondary adrenal insufficiency (43.6%), hypogonadotropic hypogonadism (33%), central hypothyroidism (25.5), mild hyperprolactinemia (24.5%), and diabetes insipidus (5.3%) were also recorded. Thirty-two percent of the patients had partial and the remaining 68% total empty sella in pituitary imaging. No significant differences were found among the partial and total empty sella subgroups in terms of hormonal deficiency.

Conclusion: Primary empty sella appears to be more frequent in multiparous women and in individuals with obesity. Radiological discrimination as partial or total empty sella seems to have no effect on the degree of hypopituitarism.