Pituitary Function in the Empty Sella Syndrome

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Abstract
The empty sella syndrome is defined as an intrasellar cisternal herniation in combination with a deformed and/or enlarged sella turcica, but without clinical signs of a pituitary adenoma. In the present study, the impact of the cisternal herniation on pituitary function was analyzed. Special emphasis was placed on the relationship between pituitary function and the size and shape of the sella and type of herniation. The diagnosis of the empty sella syndrome was verified by pneumoencephalography in 49 out of the 50 subjects examined. 15 (30%) exhibited pituitary dysfunction; 10% had panhypopituitarism, 10% isolated secondary hypogonadism with or without hyperprolactinemia, and another 8% hyperprolactinemia alone and 2% had isolated ACTH insufficiency. The observed pituitary disturbances were found in patients who had been examined for a variety of symptoms and were independent of the original reasons leading to radiological examination. Thus, pituitary dysfunction was noted in 6 out of 32 subjects (19%) originally examined for either neurological symptoms or whose sellar enlargement was found accidently. 2 had pituitary insufficiencies and 4 had hyperprolactinemia. These observations stress the importance of thorough evaluation of pituitary function in subjects with empty sella syndrome. Pituitary insufficiency was most often found in subjects with normal-sized sella. A ballooned sella was often observed in patients with normal pituitary function, whereas a deep sella was slightly more common in those with impaired pituitary function. Horizontal herniations were mostly seen in normal-sized sellae and extensive herniations in connection with deep sellae. However, the type of intrasellar herniation was not correlated to pituitary function. Demineralization and erosions of the sella turcica, indicating increased intracranial pressure and signs of disturbed cerebrospinal fluid circulation were seen in half of the patients and could not be related to pituitary function. On the other hand, the occurrence of panhypopituitarism was related to a history of meningoencephalitis or cerebrovascular accidents.