Endocrine Abstracts

Background: primary empty sella (ES) represents a frequent finding (up to 35% of the general population). According to the literature, the prevalence of hypopituitarism in ES ranges between 19-52%. Data on the natural history of ES over a long time, especially in incidental ES, are still lacking and the management can be challenging.

Objective: our primary aim was to assess in a large cohort of patients with ES the prevalence and determinants of hypopituitarism. Our secondary aim was to explore the hormonal and neuroradiological evolution after at least 6-months of follow-up.

Design and methods: retrospective and multicenter study based on medical records of all patients with ES attending four Pituitary Units between 1984-2020. The availability of the neuroimaing and hormonal assessment at diagnosis represented the inclusion criteria. Data collected at diagnosis and at the last available follow-up were analysed.

Results: 402 patients (63% females, mean age 51.5±15.5 years) were enrolled. Dynamic evaluations of pituitary function were available in 326 (81%). Longitudinal data were available in 166/402 with a median follow-up of 58 months.

Diagnosis: ES was incidentally discovered in 72% patients whereas in 28% it was diagnosed because of a suspected endocrinopathy (hypopituitarism or hyperprolactinemia). ES was partial in 66.4%, total in 13.4%, and not defined in 20.2%. Traumatic brain injury (TBI) was reported in 23% cases evaluated for this issue. In the overall group, at least one pituitary hormonal deficiency was present in 40.5% (hypogonadism=20.4%, hypoadrenalism=14.7%, GHD=14.7%, hypothyroidism=10.2%, DI=1.5%; multiple deficiencies=11%) and hyperprolactinemia in 6.5%. Hypopituitarism resulted significantly associated with male sex (P=0.03), symptoms/signs suggestive of pituitary disease (P<0.001), and TBI (P=0.004), without significant associations with age, BMI, number of pregnancies and entity of ES. Interestingly, hypopituitarism was present in 29.1% patients with incidental ES (hypoadrenalism=13.5%, GHD=12.5%, hypogonadism=8.7%, hypothyroidism=2.8%, DI=1.7%).Follow-up at the last evaluation, 5/166 (3%) patients, displayed new hormonal deficiencies and 6.1% showed a neuroradiological progression from partial to total ES. Most patients with hormonal deterioration were already hypopituitaric at diagnosis (80%). The development of new deficiencies was only associated with the increasing grade of ES (P=0.004).

Conclusions: we described one of the largest cohort of patients with primary ES. Patients with ES need to be carefully evaluated at diagnosis, even if ES is incidentally discovered. We suggest completing the assessment with dynamic tests (screening for GHD and adrenal insufficiency). Hypopituitarism is frequent (40%) but a deterioration in pituitary function seems uncommon (3%).