Pituitary Volume in Patients with Primary Empty Sella and Clinical Relevance to Pituitary Hormone Secretion: A Retrospective Single Center Study

Abstract

Background: According to neuroradiological findings, empty sella seems to be deprived of pituitary tissue in sella turcica. Changing size of the pituitary volume is closely related to the occurrence of primary empty sella. The aim of the study is to determine pituitary dysfunction in patients with partial or total primary empty sella and the significance of pituitary volume measurements in these patients. Methods: This study was designed retrospectively. 67 patients (55 females, 12 males) diagnosed with primary empty sella syndrome between the years of 2015-2019 were included in the study. Patients were divided into two groups: partial (PES) and total (TES) empty sella by magnetic resonance imaging (MRI). Basal anterior pituitary and its hormones were assessed. We also included 26 healthy control subjects (19 females, 7 males) to compare the differences in pituitary volumes. Volumes were measured by using Osirix Dicom Viewer ( Pixmeo SARL, Geneve, Swiss) in 3.0 Tesla scanner MRI. Results: 82.1% (n=55) of all patients were PES and the others were (n=12) TES. Hypopituitarism, known as one or more pituitary hormones deficiency, was found in 12 patients (17.9%). While 9 of them had total PES, the others had partial PES. Secondary adrenal insufficiency and gonadotropin deficiency were more prevalent in patients with TES. Mean volume measurements of patients with TES, PES and healthy subjects were 0.23±0.17, 0.35±0.15, 0.54±0.17 cm3, respectively. Except for IGF1 values (p=0.026), there was not any significant correlation found between the anterior pituitary hormones and volume measurements. Conclusion: Although volume measurement has helped in the diagnosis of pituitary empty sella (partial or total), it does not seem to have any significant correlation with pituitary secretory function.

The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure

“…Cerebrospinal Fluid Pressure Dysregulation Primary ES FM CFS Patients with pressure ≥ 19 cm H 2 O 62% 10 53% 4 50% 6 - Brain MRI: 55% show optic nerve sheath dilation 7 2. Hormonal anomalies Primary ES versus controls FM versus controls CFS versus controls HPA axis ACTH and cortisol levels Low ACTH and cortisol 9 , 13 , 15 , 16 Reduced cortisol in up to 62% 14 , 17 Reduced morning peak ACTH and cortisol 18 , 19 Reduced basal cortisol 1 Reduced basal cortisol 1 Challenge tests – Blunted ACTH response to CRH 20 Blunted ACTH response to hypoglycemia 21 Blunted cortisol response to dexamethasone + CRH 22 No difference in the ACTH and cortisol response to CRH or naloxone 23 Aldosterone levels – – Reduced 24 , 25 Hypothalamo-pituitary somatotropic axis Mean GH and IGF-1 levels …”

“…Low ACTH levels in primary ES were found to be associated with low cortisol levels. 9 , 13 , 15 , 16 Low cortisol levels were found in up to 62% of patients with primary ES. 14 , 17…”

“…Additionally, erectile dysfunction was reported in 53–100% of male patients, and irregular menses were reported in 40% of female patients. 10 , 12 , 14 , 16 The latter symptoms may be indications of abnormal hormone levels.…”