Abstract
The term primary empty sella (PES) makes reference to the herniation of the subarachnoid space within the sella turcica in patients with no history of pituitary tumor, surgery or radiotherapy. To retrospectively assess clinical features, radiological findings and the biochemical endocrine function from the records of 175 patients with a diagnosis of PES. One hundred seventy-five patients (150 females) were studied. The mean age at diagnosis was 48.2 ± 14 year. Most diagnoses were made by magnetic resonance imaging (n = 172). In most patients, the pituitary function was assessed by basal pituitary hormones measurements. Pituitary scans were ordered for different reasons: headache (33.1 %), endocrine disorders (30.6 %), neurological symptoms (12.5 %), visual disturbances (8.75 %), abnormalities on sella turcica radiograph (8.75 %) and others (6.25 %). Multiple pregnancies were observed in 58.3 % of women; headaches, obesity, and hypertension were found in 59.4, 49.5, and 27.3 % of the studied population, respectively. Mild hyperprolactinemia (<50 ng/ml) was present in 11.6 % of women and 17.3 % of men. Twenty-eight percent of our patients had some degree of hypopituitarism. In the male population, hypopituitarism represented 64 % of cases, whereas it accounted for 22 % of all females. PES seems to be more commonly found in middle-aged women, with a history of multiple pregnancies. In most patients, PES was discovered as an incidental finding on imaging studies, while in almost a quarter of patients PES was found during the diagnostic evaluation of anterior pituitary deficiency, which was more common in men.
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De Marinis L, Bonadonna S, Bianchi A, Giulio M, Giustina A (2005) Extensive clinical experience: primary empty sella. J Clin Endocrinol Metab 90:5471–5477
Guinto G, Mercado M, Abdo M, Nishimura E, Arechiga N, Nettel B (2007) Primary empty sella syndrome. Contemp Neurosurg 29(11):1–6
Griffits PG, Dayan M, Coulthard A (1998) Primary empty sella: cause of visual failure or chance association? Eye 12:905–906
Guinto G, del Valle R, Nishimura E, Mercado M, Nettel B, Salazar F (2002) Primary empty sella syndrome: the role of visual system herniation. Surg Neurol 58:42–48
Del Monte P, Foppiani L, Cafferata C, Rattles A, Bernasconi D (2006) Primary “empty sella”: in adults: endocrine findings. Endocr J 53(6):803–809
Sage MR, Blumbergs P (2000) Primary empty sella turcica: a radiological-anatomical correlation. Australas Radiol 44:341–348
Gallardo E, Schacter D, Caceres E, Becker P, Colin E, Martinez C, Henriquez C (1992) The empty sella: results of treatment in 76 cases and high frequency Successive endocrine and neurological of disturbances. Clin Endocrinol (Oxf) 37:529–533
Agarwal JK, Sahay RK, Bhadase SK, Reddy VS, Agarwal NK (2001) Empty sella syndrome. J Indian Acad Clin Med 2(3):198–202
Gonzalez JG, Elizondo G, Saldivar D et al (1988) Pituitary gland growth normal during pregnancy: an in vivo study using magnetic resonance imaging. Am J Med 85:217–220
Cannavo S, Curto L, Venturino M, Squadrito S, Almoto B, Narbonne MC, Rao R, Trimarchi F (2002) Abnormalities of hypothalamic-pituitary-thyroid axis in patients with primary empty sella. J Clin Endocrinol Metab 25(3):236–239
Sastre J, Herranz L, de la Morena MegíaA, Lopez Guzman A, Gómez-Pan A, Pallardo Sánchez LF (1992) Primary empty sella: clinical, radiological and hormonal. Rev Clin Esp 191:481–484
Necochea Y, Loja D, Aviles R, Vilca M (1998) Empty sella and hypopituitarism. Rev Med Hered 9(2):84–88
Sugerman HJ, DeMaria EJ, Felton WL et al (1997) Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurolgy 49:507–511
Manetti L, Lupi I, Morselli L, Albertini S, Cosottini M, Grasso L, Genovesi M, Giovanni P, Mariotti S, Bogazzi F, Bartalena L, Martino E (2007) Prevalence and functional significance of antibodies in patients with antipituitary autoimmune and non-autoimmune thyroid diseases. J Clin Endocrinol Metab 92:2176–2181
Komatsu M, Kondo T, Yamauchi K, Yokokawa N, Ichikawa K, Ishihara M, Aizawa T, Yamada T, Imai K (1988) Tanaka antipituitary antibodies in patients with the primary empty sella syndrome. J Clin Endocrinol Metab 67:633–638
De Marinis L, Mancini A, Giampietro A, Bianchi A, Tilaro L, Mangiola A, Anile C, Maira G (2004) The empty sella syndrome: characteristics and neuroendocrine general dynamics. In: Baldelli R, Casanueva FF, Tamburrano G, (eds) Update in neuroendocrinology, from basic research to clinical practice. Pubblicazioni Medico Scientifiche 2.1:291–320
Kaufman B, Tomsak RL, Kaufman BA et al (1989) Herniation of the suprasellar visual system and third ventricle Into empty sellae: morphologic and clinical considerations. AJR Am J Roentgenol 152:597–608
Brisman R, Hughes JE, Holub DA (1972) Endocrine function in nineteen patients with empty sella syndrome. J Clin Endocrinol Metab 34(3):570–573
Jordan RM, Kendall JW, Kerber CW (1977) The primary empty sella syndrome: analysis of the clinical characteristics, radiographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone concentrations. Am J Med 62:569–580
Gasperi M, Aimaretti G, Cecconi E, Colao A, Di Somma C, Cannavò S, Baffoni C, Cosottini M, Curt L, Trimarchi F, Lombardi G, Grasso L, Ghigo E, Martino E (2002) Impairment of GH secretion in adults with primary empty sella. J Endocrinol Invest 25(4):329–333
Poggi M, Monti S, Lauri C, Pascucci C, Bisogni V, Toscano V (2012) Primary empty sella and GH deficiency: prevalence and clinical implications. Ann Ist Sanita 48(1):91–96
Ho KK (2007) GH deficiency consensus workshop participants consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in Association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society and Endocrine Society of Australia. Eur J Endocrinol 157(6): 695–700
Gonzalez Tortosa J (2009) Primary empty sella: clinical, pathophysiology and treatment. Neurosurgery 20:132–151
Giustina A, Aimaretti G, Bondanelli M, Buzi F, Cannavò S, Cirillo S, Colao A, De Marinis L, Ferone D, Gasperi M, Grottoli S, Porcelli T, Ghigo E, Degli Uberti E (2010) Primary empty sella: why and when to investigate hypothalamic-pituitary function. J Endocrinol Invest 33(5):343–346
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The following hospitals of the city of Buenos Aires participated in this study: Durand, Santa Lucia, Instituto Fleni, Británico, Rivadavia, Alvarez, Clinicas, Posadas, Pirovano, Italiano, Militar, Ramos Mejia.
This study was approved by the Ethics Committees of the participating hospitals.
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Guitelman, M., Garcia Basavilbaso, N., Vitale, M. et al. Primary empty sella (PES): a review of 175 cases. Pituitary 16, 270–274 (2013). https://doi.org/10.1007/s11102-012-0416-6
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DOI: https://doi.org/10.1007/s11102-012-0416-6