A Multicenter Cohort Study in Patients With Primary Empty Sella: Hormonal and Neuroradiological Features Over a Long Follow-Up

Abstract

Objectiveprimary empty sella (PES) represents a frequent finding, but data on hormonal alterations are heterogeneous, and its natural history is still unclear. Our aim was to evaluate the pituitary function of patients with PES over a long follow-up.Designmulticenter retrospective cohort study enrolling patients referred between 1984-2020 to five Pituitary Units, with neuroradiological confirmed PES and a complete hormonal assessment.Methodswe analyzed hormonal (including basal and dynamic evaluations), clinical and neuroradiological data collected at diagnosis and at the last visit (at least 6 months of follow-up).Resultswe recruited 402 patients (females=63%, mean age=51.5 ± 16 years) with PES (partial, total, undefined in 66%, 13% and 21%, respectively). Hypopituitarism was present in 40.5% (hypogonadism=20.4%, hypoadrenalism=14.7%, growth hormone deficiency=14.7%, hypothyroidism=10.2%, diabetes insipidus=1.5%; multiple deficiencies=11.4%) and hypeprolactinemia in 6.5%. Interestingly, hormonal alterations were diagnosed in 29% of incidental PES. Hypopituitarism was associated with male sex (p=0.02), suspected endocrinopathy (p<0.001), traumatic brain injury (p=0.003) and not with age, BMI, number of pregnancies and neuroradiological grade. A longitudinal assessment was possible in 166/402 (median follow-up=58 months). In 5/166 (3%), new deficiencies occurred, whereas 14/166 (8.4%) showed a hormonal recovery. A progression from partial to total PES, which was found in 6/98 patients assessed with a second imaging, was the only parameter significantly related to the hormonal deterioration (p=0.006).Conclusionsthis is the largest cohort of patients with PES reported. Hypopituitarism is frequent (40%) but hormonal deterioration seems uncommon (3%). Patients need to be carefully evaluated at diagnosis, even if PES is incidentally discovered.

A case report and literature review of Carney complex with atrial adenomyxoma

“…In addition, the LH, FSH, and E2 levels of this patient were high. A previous study showed that only 20.4% of patients with empty sella syndrome will develop central hypogonadism [ 18 ]. Our patient was considered perimenopausal according to the gynecological consultation in her first visit and was postmenopausal 1 year later, which could explain why the changes in her LH, FSH, and E2 levels.…”

When a “Low T” Diagnosis Can Be the Clue to a More Complex Problem

“…Previous reports listed hypopituitarism in about 20% of patients [ 19 ] with primary empty sella (PES), but a recent review series noted hormonal deficiencies in 52% of the patients, and in 30% of patients multiple hormonal deficiencies were concomitantly present [ 20 ]. Growth hormone deficiency, hypogonadism, hypoadrenalism, and hypothyroidism frequency vary depending on the study [ 18 , 20 , 21 ]. Both Auer et al and Carosi et al concluded that due to the high frequency of hormonal abnormalities, all patients with incidental primary empty sella diagnosis should have an endocrinological evaluation at diagnosis [ 20 , 21 ].…”

“…Growth hormone deficiency, hypogonadism, hypoadrenalism, and hypothyroidism frequency vary depending on the study [ 18 , 20 , 21 ]. Both Auer et al and Carosi et al concluded that due to the high frequency of hormonal abnormalities, all patients with incidental primary empty sella diagnosis should have an endocrinological evaluation at diagnosis [ 20 , 21 ].…”

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

“…The prevalence of hypopituitarism in empty sella ranges from 10% to 40%. 12,13 Hypopituitarism is a common complication of both traumatic brain injury and aneurysmal subarachnoid bleeding, occurring in about 19-36% of cases. 14 Other causes of hypopituitarism in the elderly include peri-pituitary tumors, surgical or radiation treatment of the pituitary or brain tumors as well as infiltrative lesions.…”