The Ubiquitous ‘Empty’ Sella Turcica

Kaufman, Benjamin; Chamberlin, William B.

doi:10.1177/02841851720130p147

Cited by 66 publications

(23 citation statements)

References 21 publications

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

et al. 1987

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“…In most of the patients, empty sella is found incidentally. It has also been reported that 20-50% of patients have the endocrinologic dysfunction [4]; partial hypopituitarism has been described in 5% of patients, total hypopituitarism in 25% [5] and hyperprolactinemia in 10% [6]. The most frequent cause of the endocrinological dysfunction is the primary pituitary dysfunction.…”

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A Case of Hypothalamic Panhypopituitarism with Empty Sella Syndrome: Case Report and Review of the Literature

et al. 2009

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Abstract. Empty sella syndrome is frequently accompanied with pituitary dysfunction. Most of the patients with empty sella syndrome demonstrate primary pituitary or stalk dysfunction and few cases show hypothalamic dysfunction. A 71-year-old man manifested appetite loss, nausea and vomiting with hyponatremia and adrenal insufficiency. Hormonal evaluation and cranial MRI revealed a panhypopituitarism with empty sella. Intriguingly, while the response of ACTH to CRH administration was exaggerated, the response to insulin hypoglycemia was blunted. Serum PRL levels were normal. Further, decreased level of fT4, slightly elevated basal levels of TSH, and delayed response of TSH to TRH administration were observed. These findings strongly suggest that the panhypopituitarism is caused by hypothalamic dysfunction. The presence of autoantibodies to pituitary and cerebrum in the patient's serum implies an autoimmune mechanism as a pathogenesis.

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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.…”

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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. 12,15 As large tumors can fill the sella and eliminate any arachnoid herniation, ESS is more likely to present with microadenomas and hormonesecreting tumors.…”

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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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The Ubiquitous ‘Empty’ Sella Turcica

Cited by 66 publications

References 21 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

A Case of Hypothalamic Panhypopituitarism with Empty Sella Syndrome: Case Report and Review of the Literature

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

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