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Primary Empty Sella

Departments of Endocrinology (L.D.M., A.B.) and Neurosurgery (G.M.), Catholic University of Rome, 00168 Rome, Italy; and Department of Medical and Surgical Sciences (S.B., A.G.), University of Brescia, 25125 Brescia, Italy

Address all correspondence and requests for reprints to: Prof. Andrea Giustina, Endocrine Section, c/o 2° Medicina–Spedali Civili, 25125 Brescia, Italy. E-mail: a.giustina{at}libero.it.

Context: The term primary empty sella (PES) refers to a number of endocrine and/or neurological disturbances that may be caused by the herniation of subarachnoid space within the sella.

Setting: The records of all patients with a diagnosis of empty sella between 1985 and 2002 seen at the Catholic University of Rome and University of Brescia were examined retrospectively.

Patients: We have observed 171 female and 42 male patients affected by PES (over 4:1 sex ratio). The mean age at diagnosis in our subjects was 51.8 ± 2.1 yr. Mean body mass index was 27.3 ± 3.5 kg/m².

Main Outcome Measure: All the patients have been analyzed first either with sellar computed tomography scan or magnetic resonance imaging. All patients underwent neurological, ophthalmological, and baseline endocrine evaluation (appropriate stimulation tests were performed when hypopituitarism was suspected).

Results: In the overall population, 40 of 213 patients had documented endocrine abnormalities, specifically 31 females and nine males. Twenty-two patients (10.3% of total patients; 18 women, 10.5% of all women, with a mean age of 38.6 ± 1.1 yr and four males, with a mean age 46.5 ± 3.52 yr) presented with hyperprolactinemia. Global anterior hypopituitarism was confirmed in nine patients. Eight patients presented an isolated GH deficiency. One hundred thirty-eight of our patients presented a so-called partial empty sella at computed tomography scan/magnetic resonance imaging, and 75 had total PES.

Conclusions: PES may be associated with variable clinical conditions ranging from mild endocrine disturbances to severe intracranial hypertension and rhinorrhea. The need for treatment of hyperprolactinemia as well as for replacement hormone therapy must be assessed in PES. Symptomatic intracranial hypertension makes cerebrospinal fluid shunting procedures necessary.

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