The "Empty Sella" in Childhood

Abstract

The "empty sella" (ES), a common entity in adults, is so named because a cerebrospinal fluid-filled arachnoid hernia fills the pituitary fossa and compresses the pituitary gland, creating the illusion of an "empty" sella. We report our experience of ES in childhood. Our four cases represent associations with ES that have not been previously described in childhood: case 1 was associated with central precocious puberty; case 2 with secondary ES resulting from shrinkage of a prolactinoma during bromocriptine therapy; case 3 with pseudotumor cerebri; and case 4 with no significant pathology. Together, they account for approximately 1 percent of cases of radiographically enlarged sella tursica investigated here. This brings the number of cases of ES reported in children to 27. Review of these 27 cases reveals seven with local skull dysplasia and/or a familial inheritance. The remainder lacked clinical homogeneity or similarity to the common adult variety of ES. Children with ES did not exhibit the higher female preponderance reported in adults with ES. They showed a higher frequency of secondary cases (4/27), and of associated endocrine (10/15) and visual (8/17) abnormalities than is seen in adults with the "empty sella."

Hypopituitarism and Stalk Agenesis: A Congenital Syndrome Worsened by Breech Delivery?

“…Abnormal delivery, as we ob served, was reported in 50-60% of cases, most with empty sella on computed-tomographic scan [5][6][7][8][9][10][11][12][13], Al though. the association of perinatal insults with hypopi tuitarism and empty sella has already been documented [5][6][7][8][9][10][11][12][13], no evaluation of pregnancy and delivery history in GHD patients with hypothalamic-pituitary abnormal ities revealed by MRI has been reported. The MRI tech nique proved able to distinguish between GHD patients with anterior pituitary hypoplasia, stalk agenesis and posterior pituitary ectopia, who are at risk for develop ing MPHD, and those with normal pituitary gland or isolated anterior pituitary hypoplasia in whom IGHD is the commonest single hormonal defect [24].…”

Reduced Pituitary Volume in Children with Short Stature: Clinical and Radiological Correlates

“…Despite earlier studies corroborating a good correlation between sellar and pitu itary sizes in a normal population [1,29] and in children with congenital pituitary aplasia [33,34], there have been reports to the contrary [4]. The empty sella is the most recognized example of a discrepancy between a small pituitary gland and a large sella [3, 35,36].…”

Asymptomatic Primary Empty Sella in a 14-Year-Old Girl: Comparison of Computer Tomography and Nuclear Magnetic Resonance Imaging

“…Most of the few pediatric patients with an empty sella syndrome had some endocrine problem [34]; this was the presenting com plaint, however, and thus they represent a selected group. Since our case was detected by chance, she may rather be one of those 5% of a population who can be expected to have no sellar diaphragm [1] and in whom normal CSF pressure may suffice for sellar remodel ling [26][27][28].…”

“…allowing the subarachnoid space to extend into the sella as outlined in figure 1. The condition is extremely rare in children [22][23][24][25]34], We therefore report the case of a 14-yearold girl in whom an asymptomatic primary empty sella was diagnosed by chance. Com puter-assisted axial tomography could be compared for the first time with nuclear mag netic resonance (NMR) imaging in such a young patient.…”