Clinical and hormonal assessment of patients with empty sella on MRI

Introduction. Empty sella is caused by the herniation of the subarachnoid space within the sella, which results in compression of pituitary gland. The image of empty sella may be an incidental finding on MRI in asymptomatic patients, but it can be also associated with severe neurological, ophthalmological and endocrine disorders. Aim. The aim of the study was to analyze clinical and hormonal data of patients with empty sella on MRI. Material and methods. We performed a retrospective review of the medical data of patients hospitalized in the Department of Endocrinology in Bielański Hospital during one year searching for those with the diagnosis of empty sella. We collected data on the age, sex, causes of empty sella, results of pituitary function and we analysed the results of MRI of pituitary-hypothalamic region. Results. Among 1724 patients hospitalized in the Department 40 patients (2.3%) had empty sella on MRI. Twenty one (52.5%) patients were diagnosed with primary empty sella (PES) and 19 (47.5%) were diagnosed with secondary empty sella (SES). In patients with PES there were 16 (76.2%) females and 5 (23.8%) (3 to 1 ratio). More than half of PES females (53%) had a history of at least two pregnancies. The mean BMI in PES patients was 27.4 kg/m2. The mean age at diagnosis was 47.8 ± 14.6 years in the whole group. During the hormonal assessment 5 patients (23.8%) with PES were found to have some degree of anterior pituitary deficiency. The most frequent disorder (19%) was hypogonadotropic hypogonadism with symptoms of oligomenorrhoea in females and decreased sexual function in men. In seventeen patients (81%) in PES group MRI revealed partial empty sella (less than 50% of the sella filled with CSF) while in 4 patients (19%) total empty sella (more than 50% of sella filled with CSF). Conclusions. In our study, PES was more common in middle aged, overweight multiparous women. In most cases PES was incidentally discovered by imaging study, but in some it led to diagnosis of anterior pituitary deficiency during the diagnostic evaluation.