Endocrine Abstracts

Empty sella (ES) is characterized by herniation of the subarachnoid space within the sella, compression and flattening of the pituitary gland. Stretching of the pituitary stalk may also be seen. Empty sella is a frequent finding (5–23%) in autopsy series while it is < 0.01% in persons who undergo medical attention. Meanwhile there is an increase in sellar emptiness with age. Regarding pathophysiology and etiology, it may be primary to the incompetence of the diaphragma sellae and herniation of CSF in to the sella turcica. It may be secondary to pituitary autoimmune disease, brain trauma, radiation, surgery, hemorrhage, or infarction of the pituitary gland. Primary and secondary ES can be thought of and treated as one entity. As a master gland of endocrine system, hormone secretions from the pituitary gland should be evaluated if the patients have symptoms. The most common symptom associated to ES is headache. In patients with primary ES, radiological ES is found incidentally on brain MR mostly performed because of headache. Symptoms associated with endocrine abnormalities may be seen especially in those with secondary ES. We evaluated 30 patients with ES [23 female (24–80 year-old), 7 men (32–85 years-old)]. Basal hormone levels were measured and then stimulated hormone levels were evaluated if necessary by means of insulin tolerance test. In female patients: primary and secondary ES were seen in 19 and 4 patients respectively. In male patients primary and secondary ES were seen in 4 and 3 patients respectively. In women, secondary causes were 1 Sheehan syndrome, 1 transsphenoidal operation and 1 brain trauma and 1 related to Neuro-Behcet’s disease. In men, secondary causes were 1 subarachnoid haemorrhage, and 1 transsphenoidal operation and 1 brain trauma. In women with primary ES, mild hyperprolactinemia (6/19), secondary hypothyroidism (5/19), GH deficiency (2/19), and panhypopituitarim (1/19) were found. One woman had primary hypothyroidism, 3 women had adrenal adenoma (1 Conn syndrome, 2 women had nonfunctional adrenal adenomas (1 unilateral, 1 bilateral) and 2 women had intracranial hypertension with primary ES. Type 2 DM and hypertension and obesity were frequent findings in women with primary ES. In men with primary ES, 2 men had panhypopituitarism, 1 patient had mild hyperprolactinemia, 1 had secondary hypothyroidism with GH deficiency. In men with secondary ES, 2 men had hypogonadotrophic hypogonadism and one man with subarachnoidal haemorrhage had normal pituitary function. Obesity and DM were not frequent in male patients with ES.