Endocrine Abstracts

JOINT1447

Background: The number of incidental findings of primary empty sella (PES) is rising due to the increasing availability and quality of neuroradiological imaging. However, the clinical implications of PES diagnosis are not always clear, especially with respect to possible hypopituitarism at baseline and over time. The aim of this longitudinal study was to examine the emergence of potential hormone insufficiencies during follow-up and derive recommendations from that.

Methods: We conducted a retrospective, single-center analysis of patients with neuroradiologically confirmed empty sella. All patients with secondary genesis of empty sella, for example due to pituitary surgery, traumatic brain injury or radiation therapy were excluded from the study. Data regarding hormone levels, clinical presentation, pre-existing diseases and medication was analysed for the available follow-up period of each patient.

Results: 97 patients were enrolled in the study (age = 57.1 ± 16.1 years; female = 54 %; BMI = 27.2 ± 6.2 kg/m²), the diagnosis of PES was an incidental finding in 58.8 % of cases. At baseline, anterior total or partial pituitary insufficiency was diagnosed in 33 out of 97 patients, with 7 persons suffering from total anterior hypopituitarism. The most frequent finding was hypogonadism with 26 % followed by insufficiencies of the thyrotropic axis (25 %) and somatotropic axis (23 %). Adrenal deficiency was prevalent in 22 % of patients. Arginine vasopressin deficiency was found in 3 patients and hyperprolactinemia in 17 patients. Total pituitary insufficiency was not detected in any patient. Complete follow-up hormone levels were available for 44 patients. In patients with intact pituitary function at baseline, mean basal hormone levels remained stable over time, indicating resilient pituitary function in the majority of patients. 1 out of 44 patients who did not initially have an impairment of pituitary function developed an insufficiency of the corticotropic, somatotropic and gonadotropic axis during follow-up.

Conclusions: Our study shows that pituitary insufficiency is common among patients with primary empty sella. 34 % of patients had an impairment of one or more hormone axes at baseline. This emphasizes the urgent need of endocrinological assessments at diagnosis. Only one patient developed pituitary insufficiency during follow-up, indicating that worsening of pituitary function in patients with intact function at diagnosis is rare. Consequently, our data does not support regular follow-up investigations in asymptomatic PES patients with intact pituitary function at initial presentation.