Endocrine Abstracts

Introduction

Empty sella syndrome (ESS) is a rare condition in which the sella turcica is partially or completely filled with cerebrospinal fluid. ESS can be classified as primary or secondary, depending on the identification of underlying etiologies. Whether empty sella has any functional implications in causing pituitary hormonal disturbances needs to be understood. The aim of our study was to assess the incidence of pituitary hormonal disturbances in patients with ESS and to determine any association between empty sella and these hormonal abnormalities.

Methods

We report a retrospective study of 46 cases of ESS collected in the endocrinology department over the period from 1991 to 2020. The clinical and biochemical profile of ESS patients was analyzed.

Results

Our study included 46 cases with a male: female ratio of 1:3.5 suggesting female predominance. The mean age of our patients was 50.4 years (21-81 years). The frequency of primary ESS among ESS was 70% in our series. Headache was the most frequent reason for consultation, 66.67%. Obesity was noted in 20% and multiparity in 62%. On the endocrine examination, anterior pituitary insufficiency was found in 58% of cases and hyperprolactinemia in 14% of cases. Finally, 0.5% of our patients showed central diabetes insipidus. Hormone deficiency substitution was preconized. The evolution was marked by the persistence of signs of anterior pituitary insufficiency in 13% of cases and headaches with visual disorders in 48.2% of cases. The comparative study concluded that failure of lactation in the postpartum period was found to be significantly correlated with hormonal dysfunction (p=0.046). The presence of headache is significantly associated with the absence of hormonal impairment in patients with primary ESS (p= 0.01).

Discussion-conclusion

The primary empty sella syndrome is of increasing interest due to frequent radiological exploration of the sellar region using mainly MRI. It is important to consider this syndrome in front of an obese, multiparous woman with headaches, and to carry out an exhaustive hormonal and radiological exploration in order to detect hormonal deficiencies.