Endocrine Abstracts

Empty Sella (ES) represents a heterogeneous syndrome, with a completely unknown pathogenesis. Defects in the organogenesis or hypoplasia of the sellar diaphragm (associated with stable or intermittent variation of intracranial pressure and/or with pituitary volume variation) can facile the herniation of the arachnoid space into pituitary fossa and the consequently pituitary compression. ES can be the sequel of necrosis of pituitary adenomas, of hypophysitis or of brain/head trauma. In these condition, ES is defined secondary. In cases with unknown aetiology ES is defined Primary. However, actually, obesity, systemic hypertension, multiple pregnancies, diabetes mellitus and pseudotumor cerebri are considerate factor risks for the occurrence of primary ES (PES). In 50% of cases with PES a coexistent intracranial hypertension is associated, with the occurrence of neurological signs and symptoms. The clinical manifestation of PES can be insidious, with subclinical or severe symptoms, as headache or papilledema, as visual disturbance or diplopia or optic neuritis, as partial or complete hypopituitarism, also associated to hyper-prolactinemia. Pituitary Magnetic Resonance is crucial for the diagnosis and allow to distinguish between partial or complete empty sella. A complete pituitary function clinical and laboratory evaluation is required to identify and diagnose hypopituitarism condition, with basal and, if necessary, dynamic test. Moreover, measurement of intracranial pressure is suggested, though direct or indirect test, as lumbar puncture or optical nerve ultrasound to evaluate the thickness of the optic nerves. In ES affected patients, hormonal replacement therapy is required for the management of hypopituitarism. Moreover, treatment of intracranial hypertension is strongly suggested, though diuretic drugs, as acetazolamide. In cases of drug-resistant intracranial hypertension or in cases of neurological emergencies, intracranial hypertension neurosurgery treatment, as ventricular shunt placement, is recommended. A semestral or at least annual follow-up is suggested in these patients, with endocrinological, ophthalmological and neurosurgical clinical, laboratory and morphological evaluation. ES, in fact, represents a complex syndrome which requires a multidisciplinary and dedicated team, as to ensure integrated therapy charge and as to prevent the occurrence of the severe disease complications.