Endocrine Abstracts

Neuroimaging techniques have improved over the last years; hence an “empty sella” is more often incidentally diagnosed. The term “empty sella” describes a missing pituitary gland in the sella turcica. Up to now, it is not known if routine endocrine assessment is necessary in patients with primary empty sella syndrome (PES) without clinical suspicion or history of neuroendocrine disorders.

We performed a systematic literature research using the search term “empty sella“ in the databases PubMed/MEDLINE and Web of Science. Studies published between 1995 and 2015 were included according to the PRISMA four-phase flow diagram. A cross-sectional quality appraisal tool was used to assess quality of studies. Only studies in which endocrine diagnostics were performed properly according to published guidelines were included into our analysis.

A total of 615 studies were identified. We excluded all reviews, pediatric studies, animal studies and case reports (less than n=3 patients). Only 25 studies addressed the question of prevalence of neuroendocrine disturbances in PES; only 4 studies referred to an incidentally diagnosed PES. The pooled prevalence rate of hypopituitarism was 50.5%±21.6%. Isolated pituitary insufficiency was less frequent than impairment of two or more pituitary hormonal axes (22.0%±13.2% vs. 31.5±20.5%). Growth hormone deficiency was reported to be the most frequent disorder irrespective of grade of empty sella (partial or complete) or number of pituitary deficiencies. Reported prevalence of ACTH-insufficiency varied from 9 to 37.5%. Panhypopituitarism seems to be rare (reported prevalence from 0% up to 19%); likewise hyperprolactinemia (mean prevalence 12.9%±6.3%) or diabetes insipidus (reported prevalence from 0% to 5%). Overall, gender and BMI seem to be associated with the prevalence of PES, as 77.6%±11.4% of all patients were female and the mean reported BMI was 29.1±0.3 kg/m².

Data on an incidentally diagnosed empty sella in asymptomatic patients are scarce. Based on our data and on expert opinion, we recommend performing routine neuroendocrine diagnostic in patients with an incidental finding of “empty sella”.