The empty sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances

Gallardo, Enrique; Schachter, Dina; Caceres, Edith; Becker, Pedro; Colin, Enrique; Martinez, Carlos R.; Henriquez, Camilo

doi:10.1111/j.1365-2265.1992.tb01484.x

Cited by 66 publications

(32 citation statements)

References 12 publications

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“…More rarely, PES patients present with CSF rhinorrhea, visual field defects or papilledema. Previous studies have reported preserved normal pituitary function in most PES cases; partial or total hypopituitarism, however, has been described in about 25% of patients and hyperprolactinemia due to distortion of the pituitary stalk in about 10% [2][3][4][5]. GH deficiency was described in early reports [6][7][8] and more recent studies have demonstrated a decreased pituitary GH reserve in 35-60% of adult PES subjects [9][10][11].…”

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confidence: 99%

Primary "Empty Sella" in Adults: Endocrine Findings

Monte

Foppiani

Cafferata³

et al. 2006

Endocr J

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Abstract. Increasing evidence of impaired pituitary function in many subjects with primary empty sella (PES) has been reported. We conducted a retrospective analysis of our patients with PES, in order to ascertain presenting symptoms and endocrine status on diagnosis and during follow-up. Magnetic resonance imaging (MRI) of the pituitary leading to the diagnosis of PES was performed in 8 patients (5 F and 3 M, age: 60.1 ± 3.3 years, M ± SE; group 1) after the diagnosis of global anterior hypopituitarism (H), and in 20 patients (F, age 56.9 ± 2.2 years, group 2) for other clinical reasons. Baseline determinations of pituitary and target gland hormones and of IGF-I were performed. GH response to GHRH plus arginine stimulation was also evaluated. Ten age-and BMI-matched subjects (7 F, 3 M, age: 53.0 ± 4.0 years) with normal pituitary function served as controls (C). In group 1, the presenting symptoms leading to the diagnosis of H were consciousness disturbances, hyponatremia and chronic fatigue. The GH response to stimulation was absent (peak:1.0 ± 0.3 ng/ml) and IGF-I levels (60.1 ± 9.3 ng/ml) were significantly lower (p<0.001) than in C and group 2 PES patients. Among group 2 PES patients, the main presenting symptoms were headache and visual alterations. Baseline hormone levels proved normal in 17 subjects, while slight hyperprolactinemia was observed in 2 and hypogonadotropic hypogonadism in one. The GH response to stimulation (12.9 ± 3.4 ng/ml) and IGF-I levels (141.7 ± 12.0 ng/ml) were lower (p<0.05) than in C (GH: 33.4 ± 8.8 ng/ml, IGF-I: 193.1 ± 20.3 ng/ml). PES is a heterogeneous condition that ranges from hypopituitarism to various degrees of isolated GH deficiency, and which needs careful endocrine assessment, treatment and follow-up.

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confidence: 99%

Primary "Empty Sella" in Adults: Endocrine Findings

Monte

Foppiani

Cafferata³

et al. 2006

Endocr J

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“…In the present series, patients #2 and #4 had respectively partial and total empty sella, both asymptomatic and not associated with worsened visual field defects. Secondary empty sella usually develops following radiation therapy or surgery of the sellar region or during dopamine agonist treatment for prolactinomas 13,14,15 . In that scenario, visual disturbance is caused by traction of the chiasm or the optic nerves toward the sella floor by the adhesion scar or pituitary stalk 16,17,18 .…”

Section: A B Discussionmentioning

confidence: 99%

Prolactinomas may have unusual presentations resulting from massive extrasellar tumor extension

Berriel

Lima

Melo

et al. 2016

Arq. Neuro-Psiquiatr.

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The purpose of this case series is to report eight patients with giant prolactinomas emphasizing presentations and a treatment complication. The study group included six men and two women. The median age was 29 years (18–54 years); median serum prolactin level was 4,562 ng/ml (1,543–18,690 ng/ml); three patients (37.5%) had panhypopituitarism; median tumor diameter was 50 mm (41–60 mm). Five patients (62.5%) had visual field defects and three had improvement during treatment; six patients (75%) reached prolactin normalization, with a median time of 10.5 months (7–84 months) and median dose of 2.0 mg/week (1.0 to 3.0 mg/week). One patient presented as a true incidentaloma. One patient presented a cerebrospinal fluid leakage during medical treatment and refused surgery, however this resolved with conservative measures. This case series illustrate a rare subtype of macroprolactinomas, the importance of considering unusual presentations at the diagnosis, the effectiveness of pharmacological treatment and its possible complications.

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“…La rinorrea en la STVP, ha sido tratada mediante abordajes intradurales transcraneales o transesfenoidales a la silla turca, y mediante implantación sistemas de derivación de lcr, con un alto índice global (41-46%) de fracaso en el primer intento 35,37,65 , sea cual sea el tipo de intervención realizado.…”

Section: Fístula De Líquido Cefalorraquídeounclassified

Silla turca vacía primaria: clínica, fisiopatología y tratamiento

González-Tortosa

2009

Neurocirugía

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ResumenEn este artículo se revisa el concepto, clínica, fisiopatología y manejo de la silla turca vacía primaria y los distintos problemas que plantea, a la luz de la bibliografía que se ha considerado más relevante sobre el tema. ConceptoCuando en las pruebas radiológicas de imagen se encuentra una invaginación de los espacios subaracnoideos hacia el interior de la silla turca, rellenándose ésta de lcr, de manera total o parcial, se habla de Silla Turca Vacía (STV). Este concepto implica una comunicación libre entre el líquido intraselar y el de la cisterna supraselar 55 . La silla turca se encuentra normalmente ocupada en su totalidad por la hipófisis y el diafragma separa a la glándula de la cisterna supraselar. Este diafragma tiene un pequeño orificio por el que pasa el tallo hipofisario con sus vasos porta y las arterias de la trabécula 107 , normalmente situadas en ambos lados de su cara anterior. También suele haber unos repliegues subaracnoideos alrededor del tallo, que se insinúan hacia el interior de la silla turca por debajo del diafragma sellar, entre éste y la glándula.Sin embargo, este orificio diafragmático puede estar ampliado y, en un 20% de las personas, se encuentra casi ausente 16 , dejando de servir de barrera entre los espacios subaracnoideos de la base de cráneo y el contenido de la silla turca. En estos casos, si la glándula no ocupa todo el volumen sellar, el líquido cefalorraquídeo se introduce en su interior, en ocasiones ocupando todo el espacio de la fosa, dando la impresión de estar "vacía" en las pruebas de imagen, aunque siempre existe un resto glandular que, incluso en los casos extremos, tapiza su fondo. Silla turca vacía primaria y secundaria.Hay que distinguir dos tipos de silla vacía. Una originada de un proceso patológico, que puede ser o no de índole tumoral, aunque en la mayoría de los casos se trata de un adenoma que después sufre una involución, bien espontánea (apoplejía) o bien como consecuencia de su tratamiento ( Fig. 1 y 2).La consecuencia es que la cisterna aracnoidea de la base de cráneo se introduce en un espacio que ha quedado vacío dentro de la silla turca, aprovechando la dilatación del orificio diafragmático o la ausencia del diafragma de la silla. A estos casos se le denomina "Silla Turca Vacía Secundaria" (STVS).El segundo tipo de silla vacía es aquel en el que no ha existido ningún proceso patológico previo, al menos conocido. Se le denomina "Silla Turca Vacía Primaria" (STVP) y tanto su patogenia como su repercusión clínico-quirúrgica, al no estar totalmente aclaradas, son objeto de debate y sobre ellas se centrará la revisión bibliográfica de este artículo.

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The empty sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances

Cited by 66 publications

References 12 publications

Primary "Empty Sella" in Adults: Endocrine Findings

Primary "Empty Sella" in Adults: Endocrine Findings

Prolactinomas may have unusual presentations resulting from massive extrasellar tumor extension

Silla turca vacía primaria: clínica, fisiopatología y tratamiento

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