Journal of Clinical Endocrinology & Metabolism, Vol 78, 767-771, Copyright © 1994 by Endocrine Society
Empty sella in children and adolescents with possible hypothalamic- pituitary disorders
E Cacciari, S Zucchini, P Ambrosetto, G Tani, G Carla, A Cicognani, P Pirazzoli, T Sganga, A Balsamo and A Cassio
First Pediatric Clinic, University of Bologna, Italy.
Several computed tomographic scan studies have described empty sellae in
children with hypothalamic-pituitary disorders. Magnetic resonance imaging,
however, is a more precise technique for visualizing the intrasellar
content, such as the stalk and pituitary lobes. Using magnetic resonance
imaging, we studied 339 children and adolescents (mean age +/- SD, 12.7 +/-
4.5 yr) with possible hypothalamic-pituitary disorders to ascertain the
frequency of primary empty sella and examine its relationships with other
intrasellar abnormalities, pituitary function, and adverse perinatal
events. One hundred and ninety-three patients had isolated GH deficiency,
43 had multiple pituitary hormone deficiency, 10 had diabetes insipidus, 17
had hypogonadotropic hypogonadism, 5 had idiopathic delayed puberty, 47 had
precocious puberty, and 24 had other hypothalamic pituitary disorders of
hyperfunction. One tenth (10.9%) of the patients (37 cases) had empty
sella, with a marked variation of incidences among the disorders listed
above. A statistically higher frequency of subjects with empty sellae was
found only in patients with multiple pituitary hormone deficiency. Patients
with and without empty sellae were not different in regard to age or sex.
The incidence of empty sella in the various groups of patients was as
follows: isolated GH deficiency, 8.8% (17 cases); multiple pituitary
hormone deficiency, 34.9% (15 cases); hypogonadotropic hypogonadism, 5.9%
(1 case); idiopathic delayed puberty, 40% (2 cases); and precocious
puberty, 4.2% (2 cases). No patients with isolated diabetes insipidus or
other hypothalamic- pituitary disorders had empty sellae. In the patients
with empty sellae, abnormalities of the stalk or posterior lobe were found
in 1 patient with isolated GH deficiency (5.9%), 13 patients with multiple
pituitary hormone deficiency (86.7%), and no patients with puberty
disorders. Likewise, adverse perinatal events were found only in 1 patient
with isolated GH deficiency and 9 patients with multiple pituitary hormone
deficiency. These findings suggest that empty sella is not rare in children
and adolescents evaluated for hypothalamic- pituitary disorders,
particularly if there is multiple pituitary hormone deficiency. Empty sella
can be found regardless of abnormalities of the stalk and posterior lobe,
and adverse perinatal events do not seem to be the primary etiological
factor. Empty sella is usually associated with pituitary hypofunction, but
it can be found in patients with hyperfunction of the
hypothalamic-pituitary-gonadal axis.
