Endocrine Abstracts

Empty sella is an incidental finding characterised by the herniation of subarachnoid space into the sella turcica with resultant flattening of pituitary gland to varying extent. It was considered benign. But recent reviews have shown its association with some neuroendocrinopathies.

Aims and Objectives: To determine if patients with radiological diagnosis of PESS were;

1. Referred to Endocrinology team?

2. What percentage of them had pituitary hormonal assessment?

3. Association with pituitary hormonal abnormalities and which axes were involved?

4. Whether patients require clinic follow up for serial pituitary hormonal monitoring?

Materials and Methods: Patients that had a CT/MRI at our center in the last 25 years, for various reasons but with the finding of primary empty sella were included. Those with diagnosis of secondary ESS were excluded. Review of the clinical notes and search of the Endocrine unit database to determine those that had contact with the Endocrinology team, had pituitary hormonal profile, and whether these results changed overtime.

Results: A total of 62 patients were found to have radiological diagnosis of ESS. However, only 33(53%) with primary ESS were Audited. Of these, 16(48.5%) had assessment by the Endocrinology team, though 87.7% had some pituitary hormonal assessment done. 11 patients had complete pituitary hormonal profile including; prolactin, LH, FSH, IGF-1, TSH, FT4, 9am cortisol, testosterone/oestrogen done. 17 out of 33 patients had pituitary hormonal dysfunction either at baseline or during follow up, with 5 having more than one axis affected. 36.3% of patients had a change in their serial pituitary hormone estimations, either developing abnormalities, or normalising previously abnormal hormones.

Conclusions: Pituitary hormonal dysfunction is common in patients with primary ESS. They should be referred for endocrine assessment to reduce the burden of morbidity and mortality.