Endocrine Abstracts

Background: The primary empty sella (PES) is radiologically defined as partial when less than 50% of the sella is filled with cerebrospinal fluid (CSF) and pituitary gland thickness is ≥3 mm or total when more than 50% of the sella is filled with CSF and the gland thickness is ≤2 mm in diameter.The aim of our study was to evaluate clinical and radiological aspects of PES.

Methods: We retrospectively evaluated clinical features and radiological findings of 36 patients with PES followed in the internal medicine department of the Charles Nicolle’s hospital and the endocrinology department of the Military Hospital of Tunis between 1992 and 2016.

Results: Our study included 26 women and 10 men with an average age of 47.64±15.47 years [9–83]. Of the risk factors of PES, multiparity was detected in 76% of the female patients. Obesity, hypertension, diabetes mellitus and autoimmune hypothyroidism were found in 41.6%, 38.9%, 27.8% and 8.3% of the whole study group,respectively. Only one patient had idiopathic intracranial hypertension. Endocrine signs were the most common presenting symtoms (52.7%). More than half of our patients complained of headache. The diagnosis was confirmed by pituitary magnetic resonance imaging (MRI) in the majority of cases. Sixty one of the patients had partial empty sella and the remaining 39% had total empty sella. Other radiological abnormalities on MRI were associated with PES: an absence of the normal posterior pituitary bright signal in 2 patients consulting for polyuria and an optic chiasm ptosis in a patient with campimetric defect. No significant differences were found among the partial and total empty sella subgroups in terms of risk factors of PES.

Conclusion: PES is a radiological entity that is often asymptomatic and discovered fortuitously but can induce variable neurological, hormonal and ophthalmological disorders. This diagnosis must be evoked in a middle-aged, obese, multiparous and hypertensive woman presenting with a symptomatology suggestive of pituitary deficiency or chronic headache.