Anatomical Variations in the Pituitary Gland and Adjacent Structures in 225 Human Autopsy Cases

Bergland, Richard M.; Ray, Bronson S.; Torack, Richard M.

doi:10.3171/jns.1968.28.2.0093

Cited by 372 publications

(123 citation statements)

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“…The primary empty sell syndrome is a common disorder, with prevalence rates from autopsy series of5.5to23.5% Fig.4 (Busch, 1951;Bergland et al, 1968;Kaufman and Chamberlin, 1972), and 33% of patients with an enlarged sella turcica are found to have an empty sella (Weisberg et al, 1976). Pituitary function is usually normal in patients with the primary empty sella syndrome (Jordan et al, 1977;Bergeron et al, 1979), and it is seldom reported that the primary empty sella syndrome is associated with panhypopituitarism (Cupps and Woolf, 1978).…”

Section: Discussionmentioning

confidence: 99%

A case of Hyponatremia in Panhypopituitarism Caused by the Primary Empty Sella Syndrome

et al. 1987

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Section: Discussionmentioning

confidence: 99%

A case of Hyponatremia in Panhypopituitarism Caused by the Primary Empty Sella Syndrome

et al. 1987

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“…Empty sella is characterized by the herniation of the subarachnoid space within the sella, which is often associated with variable degree of flattening of the pituitary gland (1,2). Empty sella is classified as primary or secondary (3).…”

Section: Introductionmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

Chiloiro¹,

Giampietro²,

Bianchi³

et al. 2017

European Journal of Endocrinology

113

149

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Primary empty sella (PES) is characterized by the herniation of the subarachnoid space within the sella, which is often associated with variable degrees of flattening of the pituitary gland in patients without previous pituitary pathologies. PES pathogenetic mechanisms are not well known but seem to be due to a sellar diaphragm incompetence, associated to the occurrence of upper sellar or pituitary factors, as intracranial hypertension and change of pituitary volume. As PES represents in a majority of cases, a neuroradiological findings without any clinical implication, the occurrence of endocrine, neurological and opthalmological symptoms, due to the above describes anatomical alteration, which delineates from the so called PES syndrome. Headache, irregular menses, overweight/obesity and visual disturbances compose the typical picture of PES syndrome and can be the manifestation of an intracranial hypertension, often associated with PES. Although hyperprolactinemia and growth hormone deficit represent the most common endocrine abnormalities, PES syndrome is characterized by heterogeneity both in clinical manifestation and hormonal alterations and can sometime reach severe extremes, as occurrence of papilledema, cerebrospinal fluid rhinorrhea and worsening of visual acuity. Consequently, a multidisciplinary approach, with the integration of endocrine, neurologic and ophthalmologic expertise, is strongly advocated and recommended for a properly diagnosis, management, treatment and follow-up of PES syndrome and all of the related abnormalities.

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“…5,9,14,22 The etiology of primary ESS is unknown but likely requires a congenitally incompetent diaphragma sellae and may be related to increased intracranial pressure or changes in pituitary gland volume associated with pregnancy. 11 Empty sella syndrome is an incidental finding in many patients but may be associated with symptoms of headache and endocrine disturbance.…”

Section: Discussionmentioning

confidence: 99%

“…5,9,14,22 Empty sella syndrome can be partial or complete depending on the degree to which CSF occupies the intrasellar space. 14,22 Primary ESS is typically an incidental finding and infrequently exhibits clinical manifestations on its own; however, primary ESS and pituitary tumors can occur concurrently.…”

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Effect of primary empty sella syndrome on pituitary surgery for Cushing's disease

Mehta

Bakhtian

Oldfield

2014

JNS

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Object. Primary empty sella syndrome (ESS) results from herniation of arachnoid mater into the pituitary fossa. It has been suggested to have a negative effect on pituitary surgery; however, outcomes in this cohort have not been defined. This study was performed to determine the effect of ESS on immediate and long-term biochemical outcome after pituitary surgery for Cushing's disease (CD).Methods. Using a matched cohort study design, the authors followed patients treated with pituitary surgery for CD with and without ESS. Complete ESS was defined as pituitary gland height ≤ 2 mm, whereas partial ESS was defined as pituitary gland height > 2 mm but less than three-quarters of the total sellar depth. The primary end points were immediate and long-term biochemical outcome. Cerebrospinal fluid leaks were recorded as a secondary end point.Results. Seventy-eight patients with CD and primary ESS were identified and matched with 78 patients with CD without ESS. After surgical management, immediate biochemical remission was achieved in 69 patients (88%) with ESS and 75 controls (96%, p = 0.10). Long-term remission was achieved in most patients in both groups (5-year cure: 85% vs 92%, p = 0.10). Among patients with ESS, the presence of complete ESS predicted a worse long-term outcome (p = 0.04). Intraoperative CSF leaks were significantly more frequent with ESS (54% vs 24%, p < 0.001), and despite sellar floor repair, the rate of postoperative CSF leaks was also increased (6% vs 3%, p = 0.27).Conclusions. Biochemical outcome after pituitary surgery for CD was worse in patients with complete ESS, and the risk of a CSF leak was increased with both partial and complete ESS. However, as outcome remains superior to those following alternative therapies and the biology of these tumors is unchanged in the setting of ESS, pituitary surgery should remain the initial treatment of choice. (http://thejns.org/doi/abs/10.3171/2014.3.JNS132012) Key wOrDS • Cushing's disease • empty sella syndrome • pituitary adenoma • transsphenoidal surgery • pituitary surgeryAbbreviations used in this paper: ACTH = adrenocorticotropin; BMI = body mass index; CD = Cushing's disease; CRH = corticotropin-releasing hormone; DI = diabetes insipidus; ESS = empty sella syndrome; GH = growth hormone; SIADH = syndrome of inappropriate antidiuretic hormone; UFC = urinary free cortisol.

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Anatomical Variations in the Pituitary Gland and Adjacent Structures in 225 Human Autopsy Cases

Cited by 372 publications

References 10 publications

A case of Hyponatremia in Panhypopituitarism Caused by the Primary Empty Sella Syndrome

A case of Hyponatremia in Panhypopituitarism Caused by the Primary Empty Sella Syndrome

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

Effect of primary empty sella syndrome on pituitary surgery for Cushing's disease

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