The Primary Empty Sella an Endocrine Study on 12 Cases

Abstract

Twelve patients (10 women and 2 men) with a primary empty sella turcica were studied. Endocrine function tests were performed as follows: growth hormone (GH) was measured after insulin-induced-hypoglycaemia, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) after LH-releasing hormone, thyrotrophin (TSH) and prolactin after thyrotrophin-releasing hormone; pituitary reserve of adrenocorticotrophin (ACTH) was determined by measurement of plasma cortisol after lysinevasopressin and 11 deoxycortisol after metyrapone. Five of the patients (group A) had no endocrine disturbance. Seven patients (group B) had a hypothalamo-pituitary disorder. Two of them had panhypopituitarism which appeared in one case after meningoencephalitis and in the other after a severe cranial trauma. In two cases an amenorrhoea-galactorrhoea syndrome with increased prolactin level (68 and 230 ng/ml) led to a diagnosis of a prolactin producing adenoma, which was confirmed by surgery. Finally three cases of amenorrhoeagalactorrhoea, with normal prolactin level, and/or diabetes insipidus remained unexplained. However, no causal relationship could be demonstrated between the pituitary disturbance and the "empty sella". Primary empty sella turcica is therefore a neuroanatomical and neuroradiological entity with no endocrine implication. A pituitary disorder might suggest a microadenoma or an incidentally associated disease.The term primary empty sella is used to denote intrasellar arachnoid invagina¬ tion of the chiasmatic cistern probably due to incomplete congenital development of the sellar diaphragm (Busch 1951). It also includes intrasellar arachnoidal cyst and even spontaneous necrosis of pituitary adenomas which are often Hôpital de la Pitié, 75013 -Paris

Primary Empty Sella

“…The compression of the pituitary gland and/or the pituitary stalk can cause insufficient function of the gland (34,35). In the literature (36), global hypopituitarism has been thought to be rare (about 2% of the patients with PES).…”

Primary Empty Sella Syndrome With Panhypopituitarism, Diabetes Insipidus, and Visual Field Defects

“…(1975) noted a 16°/o incidence in a review of 130 patients, a frequency con¬ firmed by Schaison 8c Metzger (1976) and Jordan et al (1977).…”

“…The association of visual field abnormalities1) with the primary empty sella syndrome is well known (Robertson 1967;Walsh 8c Hoyt 1969;Mortara 8c Norell 1970;Matisonn 8c Pimstone 1973;Dahlstrom 8c Acers 1975;Buckman et al 1976;Schaison 8c Metzger 1976;Martin et al 1977;Jordan et al 1977). …”

Symptomatic hypopituitarism revealing a primary empty sella turcica

“…Diabetes insipidus associated with primary empty sella syndrome was reported in 4 cases (Schaison and Metzger, 1969;Cupps and Wolff, 1978;Marisson and Pimstone, 1973). Two cases with gonadotropic insufficiency (Neelon et al, 1973;Bernasconi, Giovanelli and Papo, 1972) myxoedema (Neelon et al, 1973;Cupps and Woolf, 1978), one patient was admitted with generalized weakness and loss of appetite (Mortara and Norrell, 1970), and two subjects had a picture of panhypopituitarism (without further details), secondary to meningo-encephalitis and cranial trauma respectively (Schaison and Metzger, 1969).…”

“…In a few cases, hormonal disturbances could be related to the association of empty sella turcica with the infarction of a hormonally active pituitary adenoma revealed at pneumoencephalography (5 cases of prolactinomas (Jordan et al, 1977;Schaison and Metzger, 1969;Bar, Mazzaferri and Malarkey, 1975;Bryner and Greenblatt, 1977), 2 cases of Cushing's disease (Ganguly et al, 1976;Mortara and Norrell, 1970), 2 cases of acromegaly (Neelon et al, 1973;Molitch et al, 1977). Diabetes insipidus associated with primary empty sella syndrome was reported in 4 cases (Schaison and Metzger, 1969;Cupps and Wolff, 1978;Marisson and Pimstone, 1973).…”