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Manavela, Marcos; Goodall, C. M.; Katz, Silvia B; Moncet, Daniel; Bruno, Oscar D.

doi:10.1023/a:1015310806063

Cited by 23 publications

(6 citation statements)

References 22 publications

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“…The surgical outcome highly depends on tumoral characteristics and the morphological con guration of sella. Previous reports suggest more CSF leakage and hormonal dysfunction in patients with Cushing disease and ES 5 . Also, studies on patients with acromegaly have suggested those patients with coexistent ES may be less likely to bene t from transsphenoidal resection 3 .…”

Section: Introductionmentioning

confidence: 79%

Primary Empty Sella and Acromegaly: Case Series and Systematic Review

Sharifi

Ohadi

Azadi

et al. 2022

Preprint

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Purpose: Investigating Primary empty sella (ES) in patients with acromegaly for possible etiology, complications, and treatment options. Method: We searched for primary ES, among 220 acromegaly patients referred to our center from 2013 to 2020. Data were collected from hospital records and were completed through phone calls with patients. Finally, we conducted a systematic literature review of previous reports for patients with primary ES and acromegaly who underwent transsphenoidal surgery. Result: We found 31 patients with primary ES. The mean age was 46 years with a male to female ratio of 12:11. Surgical data was available for 23 patients. Total ES was found in 18 patients. Six patients had adenoma invasion into the clivus or sphenoid sinus. The tumor extended into the cavernous sinus in 10 patients. CSF leak was observed in three patients during surgery. Hormonal laboratory data were available for 17 patients. GH/IGF1 was controlled without any replacement therapy in nine patients. The most common simultaneous hormonal disturbance was high prolactin levels. No pituitary hormonal abnormalities occurred after transsphenoidal surgery except for hypothyroidism in one patient. Conclusion: Primary ES is not an unusual finding in acromegaly patients. Transsphenoidal surgery as a first-line treatment carries a reasonable complication rate.

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Section: Introductionmentioning

confidence: 79%

Primary Empty Sella and Acromegaly: Case Series and Systematic Review

Sharifi

Ohadi

Azadi

et al. 2022

Preprint

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“…EST syndrome is characterized by herniation of the subarachnoid space into the intrasellar space with compression of the pituitary gland into the posteroinferior wall [ 3 ]. This is likely to obscure the presence of underlying pituitary mass.…”

Section: Discussionmentioning

confidence: 99%

“…The association between EST syndrome and Cushing's disease has been reported infrequently. A retrospective study of 68 patients with Cushing's disease found that 16% of these have EST syndrome [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…This was attributed to ICHTN and pituitary gland compression [ 1 ]. Although surgery is curative in 70-90% of cases, EST syndrome was found to have higher risk of postoperative complications among those with Cushing's disease including diabetes insipidus, hypopituitarism, and CSF leakage [ 3 ]. This is usually because in the case of MRI-negative Cushing's disease with total EST syndrome, empiric surgical exploration is sought after inferior petrosal sampling confirms the pituitary origin of excess ACTH, and postoperative remission indicates adequate tumor resection [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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Cushing's Disease Associated With Partially Empty Sella Turcica Syndrome: A Case Report

Habib¹,

Abu-Abaa²,

Redjal³

2023

Cureus

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The association between empty sella turcica (EST) syndrome and Cushing's disease has been rarely reported. It is plausible to hypothesize that EST syndrome in association with Cushing's disease can be attributed to intracranial hypertension. In this case report, we present a 47-year-old male patient who presented with weight loss, fatigue, easy bruising, acanthosis nigricans, and skin creases hyperpigmentation. Investigations revealed hypokalemia and confirmed the diagnosis of Cushing's disease. Magnetic resonance imaging (MRI) brain showed a partial EST syndrome and a new pituitary nodule as compared with previous brain imaging. Transsphenoidal surgery was pursued and was complicated by cerebrospinal fluid leakage. This case reflects the rare association of EST syndrome and Cushing's disease, suggesting the increased risk of postoperative complications in this setting and the diagnostic challenge that EST syndrome imposes. We review the literature for a possible mechanism of this association.

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“…Empty sella has been detected in ACTH and GH-secreting adenomas ( 2 ). Previous reports suggest higher rates of peri-operative cerebrospinal fluid (CSF) leakage and hormonal dysfunction in corticotropic adenomas and empty sella ( 4 ). Additionally, controversy exists around the role of transsphenoidal resection in acromegaly patients with coexisting empty sella ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Empty sella in somatotropic pituitary adenomas; a series of 23 cases

Sharifi,

Mohammadi,

Paraandavaji

et al. 2024

Front. Surg.

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PurposeWe aimed to investigate empty sella syndrome in somatotrophic pituitary adenoma for possible etiology, complications, and treatment options.MethodAmong over 2,000 skull base masses that have been managed in our center since 2013, we searched for growth hormone-producing adenomas. Clinical, surgical, and imaging data were retrospectively collected from hospital records to check for sella that lacked pituitary tissue on routine imaging.ResultIn 220 somatotrophic adenomas, 23 patients had an empty sella with surgical and follow-up data. The mean age of the sample was 46 years with the same male-to-female ratio. Five cases had partial empty sella and the rest were complete empty sellas. The most common simultaneous hormonal disturbance was high prolactin levels. Six had adenoma invasion into the clivus or sphenoid sinus and 10 had cavernous sinus intrusion. Peri-operative low-flow and high-flow cerebrospinal fluid (CSF) leaks were encountered in one and two patients, respectively, which were successfully sealed by abdominal fat. The majority of cases required growth hormone replacement therapy while it was controlled without any replacement therapy in nine patients. No pituitary hormonal disturbance occurred after transsphenoidal surgery except for hypothyroidism in one patient.ConclusionAn empty sella filled with fluid can be detected frequently in pituitary adenomas, especially in the setting of acromegaly. The pituitary gland may be pushed to the roof of the sella and might be visible as a narrow rim on imaging or may be detected in unusual places out of the sella. The pathophysiology behind such finding originates from soft and hard tissue changes and CSF pressure alternations during abundant growth hormone production.

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Untitled

Cited by 23 publications

References 22 publications

Primary Empty Sella and Acromegaly: Case Series and Systematic Review

Primary Empty Sella and Acromegaly: Case Series and Systematic Review

Cushing's Disease Associated With Partially Empty Sella Turcica Syndrome: A Case Report

Empty sella in somatotropic pituitary adenomas; a series of 23 cases

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