Endocrine Abstracts

JOINT489

Introduction: In most cases, empty sella is an incidental neuroradiological finding associated with varying degrees of pituitary gland flattening, often without clinical significance. However, empty sella syndrome (ESS) involves pituitary hormonal dysfunction, typically hypopituitarism, presenting with heterogeneous clinical manifestations and hormonal alterations that can occasionally be severe. Significant variability in data and underestimation of findings have left much of this condition underexplored. This study evaluates pituitary function in patients with ESS over an extended follow-up period, providing insights into its pathogenesis and management.

Design: A single-centre, retrospective cohort study conducted from 2003 to 2024, including patients from our endocrinology outpatient clinic with neuroradiologically confirmed ES and comprehensive hormonal assessments.

Methods: Hormonal (including basal and dynamic stimulation tests), biochemical, clinical, and neuroradiological data were analyzed at diagnosis and follow-up (minimum of three months).

Results: A total of 101 patients (77% female, mean age 54.5 ± 15 years) were included. ESS was categorized functionally as partial (63.4%), total (6.9%), or without pituitary deficiency (29.7%). Hypopituitarism was observed in 66.3%, with hypogonadism (5.9%), secondary adrenal insufficiency (30.7%), growth hormone deficiency (3.9%), hypothyroidism (3%), diabetes insipidus (4%), hyperprolactinemia (12.9%), and multiple deficiencies (5.9%). Post hoc pairwise analysis revealed that partial ES was associated with a higher likelihood of pituitary insufficiency compared to total ES in both females (P = 0.0030) and males (P = 0.0226). Among females, total ES showed a significant association with pituitary deficiency absence compared to partial ES (P = 0.0344). Multinomial regression indicated men had a lower but marginally non-significant odds of secondary adrenal insufficiency (P = 0.052), while women exhibited a greater likelihood of hypoadrenalism compared to hypogonadism, diabetes insipidus, or hyperprolactinemia. MRI findings were marginally significant for hypogonadism (P = 0.042) but not for other hormonal alterations. A significant association was observed between MRI findings and PES type (P = 0.047).

Conclusions: This cohort study identifies novel epidemiological features of ES, revealing that nearly two-thirds develop hypopituitarism and over 30% experience secondary adrenal insufficiency. These findings emphasize the necessity for further research into its pathogenesis, tailored management approaches, and vigilant monitoring for early identification and treatment of hormonal deficiencies.

Keywords: empty sella, hypopituitarism, hypogonadism, hypoadrenalism, hyperprolactinemia, neuroendocrinology, hormonal assessment.