Endocrine Abstracts

JOINT1210

Introduction: Empty sella is a radiological finding characterized by herniation of the subarachnoid space into the sella turcica, leading to a reduction in pituitary gland thickness. It can be classified either as primary, if no preceding pituitary pathology is known or as secondary to pituitary disorders, treatment affecting the sellar region and brain injury. Primary empty sella may result from increased intracranial pressure or insufficiency of the sellar diaphragm. Factors contributing to this condition include obesity, hypertension, multiple pregnancies and female sex. The aim of this study was to characterize clinical features of primary empty sella.

Methods: We retrospectively analysed clinical data of 76 patients diagnosed with primary empty sella at the Department of Endocrinology, Metabolism and Internal Medicine in Poznan between 2011 and 2023.

Results: The majority of the cohort were women (58/76, 76%). Mean age of the diagnosis was 51 (SD 15.42) years. Partial empty sella (51/76, 67%) was more prevalent than complete empty sella (25/76, 33%). The symptoms leading to diagnosis included headaches (27/76, 35%), vertigo (6/76, 8%), irregular menstruation (4/76, 5%), recurrent syncope (3/76, 4%) and visual disturbances (2/76, 3%). Additionally, 9% (7/76) were diagnosed during evaluation of pituitary insufficiency, and 35% (27/76) were incidental findings. Obesity was present in 43% (33/76) of patients and overweight in 33% (25/76). Diabetes was diagnosed in 14% (11/76), while prediabetes was observed in 28% (21/76). A significant proportion of the cohort exhibited dyslipidaemia (43/76, 57%). Hypertension was also prevalent, affecting 53% (40/76) of patients. Hypopituitarism was diagnosed in 17% (13/76) of patients. The most common pituitary deficiency was hypogonadotropic hypogonadism, which was observed in 11 cases. Notably, two men had a history of anabolic steroid use, suggesting alternative potential cause for hypogonadism. Two or more pituitary hormone axes were affected in 77% (10/13), and among these, 90% (9/10) exhibited complete empty sella on MRI. Additionally, hyperprolactinemia was present in 5% (4/76) of patients.

Conclusions: Primary empty sella occurs predominantly in women with abnormal body weight and commonly presents with headaches. Hypertension, glucose intolerance and dyslipidaemia are frequently observed. A significant proportion of patients exhibit pituitary dysfunction, often with multiple axes involved, especially when complete empty sella is diagnosed. A substantial prevalence of metabolic comorbidities and hypopituitarism highlights the need for comprehensive evaluation and management in this patient population.