Empty Sella

#med #disease #y2023 #neuro #endo

Presentation :

Describes a radiologic finding on MRI consisting of an enlarged sella turcica not entirely filled by pituitary tissue.
- Most often incidental and seen in 8% to 35% of MRIs
- The incidence is greater in women with a 5:1 ratio

Primary empty sella is caused by herniation of subarachnoid space and fluid into the sella, compressing the normal pituitary gland
- herniation is caused by sellar diaphragm incompetence, increased intracranial pressure, or volumetric changes in the pituitary gland
Secondary empty sella can be related to pituitary tumor infarction (mostly macroadenomas), infection, autoimmune disease, trauma, or radiotherapy

Asymptomatic patients should be screened with prolactin, 8 AM cortisol, and TSH and free thyroxine (T4) levels
- Patients with an empty sella usually have normal pituitary function, but should screen for pituitary deficiency with above.
- Asymptomatic patients with empty sella are unlikely to develop hormonal or radiologic changes; however, because of the theoretical risk of progression, repeat endocrine and radiologic evaluation in 24 to 36 months is recommended. If no progression occurs, further evaluation can be limited to those who require it clinically.