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empty sella syndrome

Etiology: 1) may be normal variant 2) may occur in association with other pituitary disorders - pituitary microadenomas 3) may be associated with a) previous pituitary surgery b) pituitary radiation c) pituitary apoplexy d) Sheehan's syndrome e) lymphocytic hypophysitis f) idiopathic hypopituitarism Epidemiology: - commonly seen in obese women evaluated for headache Pathology: - sella turcica enlarged & not entirely filled with pituitary tissue [2] - herniation of CSF from the suprasellar cisterns into the sella causing pituitary compression & generally sella turcica enlargement Clinical manifestations: 1) intracranial pressure may be increased 2) visual changes 3) hypopituitarism is rare 4) headache Laboratory: - laboratory assessment for pituitary deficiency - serum IGF-1 - serum cortisol (AM) - may be optional - ADH (serum sodium, serum osmolality, urine sodium, urine osmolality) - serum TSH with reflex free T4 - serum LH serum FSH, 8 AM serum testosterone (male) serum estradiol (female) Radiology: 1) lateral skull film may show ballooned or cup-shaped sella turcica 2) myelographic dye may remain in sella of patients who have had prior myelograms 3) CT or MRI* shows: a) sella filled with CSF b) pituitary stalk is midline & extends down to the compressed pituitary on the floor of the sella * empty sella is a radiologic finding, not a distinct clinical entity [2] Differential diagnosis: - pituitary tumor

Related

hypopituitarism lymphocytic (autoimmune) hypophysitis pituitary apoplexy sella turcica (hypophyseal fossa) Sheehan's syndrome

General

pituitary disease syndrome

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 197
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2022.
  3. Guitelman M, Garcia Basavilbaso N, Vitale M et al Primary empty sella (PES): a review of 175 cases. Pituitary. 2013 Jun;16(2):270-4. Review. PMID: 22875743
  4. NINDS Empty Sella Syndrome Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Empty-Sella-Syndrome-Information-Page