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Current Medical Imaging

Author(s): Gamze Akkus*, Sinan Sözütok, Fulya Odabaş, Bilen Onan, Mehtap Evran, Barış Karagun, Murat Sert and Tamer Tetiker

DOI: 10.2174/1573405617666210525111218

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Pituitary Volume in Patients with Primary Empty Sella and Clinical Relevance to Pituitary Hormone Secretion: A Retrospective Single Center Study

Article ID: e250521193562 Pages: 7

  • * (Excluding Mailing and Handling)

Abstract

Background: According to neuroradiological findings, empty sella seems to be deprived of pituitary tissue in sella turcica. Changing size of the pituitary volume is closely related to the occurrence of primary empty sella. The aim of the study is to determine pituitary dysfunction in patients with partial or total primary empty sella and the significance of pituitary volume measurements in these patients.

Methods: This study was designed retrospectively. 67 patients (55 females, 12 males) diagnosed with primary empty sella syndrome between the years of 2015-2019 were included in the study. Patients were divided into two groups: partial (PES) and total (TES) empty sella by magnetic resonance imaging (MRI). Basal anterior pituitary and its hormones were assessed. We also included 26 healthy control subjects (19 females, 7 males) to compare the differences in pituitary volumes. Volumes were measured by using Osirix Dicom Viewer (Pixmeo SARL, Geneve, Swiss) in 3.0 Tesla scanner MRI.

Results: 82.1% (n=55) of all patients were PES and the others were (n=12) TES. Hypopituitarism, known as one or more pituitary hormones deficiency, was found in 12 patients (17.9%). While 9 of them had total PES, the others had partial PES. Secondary adrenal insufficiency and gonadotropin deficiency were more prevalent in patients with TES. Mean volume measurements of patients with TES, PES and healthy subjects were 0.23±0.17, 0.35±0.15, 0.54±0.17 cm3, respectively. Except for IGF1 values (p=0.026), there was not any significant correlation found between the anterior pituitary hormones and volume measurements.

Conclusion: Although volume measurement has helped in the diagnosis of pituitary empty sella (partial or total), it does not seem to have any significant correlation with pituitary secretory function.

Keywords: Partial empty sella, total empty sella, pituitary volume, hypopituitarism, magnetic resonance imaging, herniation.

Graphical Abstract

[1]
Maira G, Anile C, Mangiola A. Primary empty sella syndrome in a series of 142 patients. J Neurosurg 2005; 103(5): 831-6.
[http://dx.doi.org/10.3171/jns.2005.103.5.0831] [PMID: 16304986]
[2]
Guitelman M, Garcia Basavilbaso N, Vitale M, et al. Primary empty sella (PES): a review of 175 cases. Pituitary 2013; 16(2): 270-4.
[http://dx.doi.org/10.1007/s11102-012-0416-6] [PMID: 22875743]
[3]
Bergland RM, Ray BS, Torack RM. Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J Neurosurg 1968; 28(2): 93-9.
[http://dx.doi.org/10.3171/jns.1968.28.2.0093] [PMID: 5638016]
[4]
Foresti M, Guidali A, Susanna P. Primary empty sella. Incidence in 500 asymptomatic subjects examined with magnetic resonance. Radiol Med (Torino) 1991; 81(6): 803-7.
[PMID: 1857785]
[5]
Gallardo E, Schächter D, Cáceres E, et al. The empty sella: Results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances. Clin Endocrinol (Oxf) 1992; 37(6): 529-33.
[http://dx.doi.org/10.1111/j.1365-2265.1992.tb01484.x] [PMID: 1286523]
[6]
Chiloiro S, Giampietro A, Bianchi A, et al. Diagnosis of endocrine disease: Primary empty sella: A comprehensive review. Eur J Endocrinol 2017; 177(6): R275-85.
[http://dx.doi.org/10.1530/EJE-17-0505] [PMID: 28780516]
[7]
Morris PP, Lachman N, Black DF, Carter RA, Port J, Campeau N. Increased curvature of the tentorium cerebelli in idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2017; 38(9): 1789-93.
[http://dx.doi.org/10.3174/ajnr.A5289] [PMID: 28663268]
[8]
Loh WA, Sittampalam K, Tan SC, Chandran M. Symptomatic empty sella syndrome: an unusual manifestation of Erdheim–Chester disease. Endocrinol Diabetes Metab Case Rep 2015; 140122.
[9]
De Marinis L, Bonadonna S, Bianchi A, Maira G, Giustina A. Primary empty sella. J Clin Endocrinol Metab 2005; 90(9): 5471-7.
[http://dx.doi.org/10.1210/jc.2005-0288] [PMID: 15972577]
[10]
Xu P, He H, Chen Y, Wang C, Zhu Y, Ye X. Osteoporotic fractures and persistent non-fusion of the hand epiphyses caused by empty sella syndrome in an adult: a case report. J Int Med Res 2013; 41(5): 1768-72.
[http://dx.doi.org/10.1177/0300060513490609] [PMID: 24029021]
[11]
Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81(13): 1159-65.
[http://dx.doi.org/10.1212/WNL.0b013e3182a55f17] [PMID: 23966248]
[12]
Pompili A, Calvosa F, Appetecchia M. Evolution of primary empty sella syndrome. Lancet 1990; 336(8725): 1249.
[http://dx.doi.org/10.1016/0140-6736(90)92862-C] [PMID: 1978086]
[13]
Cannavò S, Curtò L, Venturino M, et al. Abnormalities of hypothalamic-pituitary-thyroid axis in patients with primary empty sella. J Endocrinol Invest 2002; 25(3): 236-9.
[http://dx.doi.org/10.1007/BF03343996] [PMID: 11936465]
[14]
Atmaca M, Baykara S, Mermi O, Yildirim H, Akaslan U. Pituitary volumes are changed in patients with conversion disorder. Brain Imaging Behav 2016; 10(1): 92-5.
[http://dx.doi.org/10.1007/s11682-015-9368-6] [PMID: 25877743]
[15]
Peper JS, Brouwer RM, van Leeuwen M, et al. HPG-axis hormones during puberty: a study on the association with hypothalamic and pituitary volumes. Psychoneuroendocrinology 2010; 35(1): 133-40.
[http://dx.doi.org/10.1016/j.psyneuen.2009.05.025] [PMID: 19570613]
[16]
Simmons JG, Whittle SL, Patton GC, et al. Study protocol: imaging brain development in the Childhood to Adolescence Transition Study (iCATS). BMC Pediatr 2014; 14(1): 115.
[http://dx.doi.org/10.1186/1471-2431-14-115] [PMID: 24779869]
[17]
Takano K, Utsunomiya H, Ono H, Ohfu M, Okazaki M. Normal development of the pituitary gland: assessment with three-dimensional MR volumetry. AJNR Am J Neuroradiol 1999; 20(2): 312-5.
[PMID: 10094362]
[18]
Giustina A, Aimaretti G, Bondanelli M, et al. Primary empty sella: Why and when to investigate hypothalamic-pituitary function. J Endocrinol Invest 2010; 33(5): 343-6.
[http://dx.doi.org/10.1007/BF03346597] [PMID: 20208457]
[19]
Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F, Donmez H. Empty sella may be the final outcome in lymphocytic hypophysitis. Endocr Res 2009; 34(1-2): 10-7.
[http://dx.doi.org/10.1080/07435800902841306] [PMID: 19557587]
[20]
Del Monte P, Foppiani L, Cafferata C, Marugo A, Bernasconi D. Primary “empty sella” in adults: endocrine findings. Endocr J 2006; 53(6): 803-9.
[http://dx.doi.org/10.1507/endocrj.K06-024] [PMID: 16983177]
[21]
Julayanont P, Karukote A, Ruthirago D, Panikkath D, Panikkath R. Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects. J Pain Res 2016; 9: 87-99.
[PMID: 26929666]
[22]
Ghatnatti V, Sarma D, Saikia U. Empty sella syndrome - beyond being an incidental finding. Indian J Endocrinol Metab 2012; 16(Suppl. 2): S321-3.
[PMID: 23565413]
[23]
Gruner P, Christian C, Robinson DG, et al. Pituitary volume in first-episode schizophrenia. Psychiatry Res 2012; 203(1): 100-2.
[http://dx.doi.org/10.1016/j.pscychresns.2011.09.017] [PMID: 22858406]
[24]
Poggi M, Monti S, Lauri C, Pascucci C, Bisogni V, Toscano V. Primary empty sella and GH deficiency: prevalence and clinical implications. Ann Ist Super Sanita 2012; 48(1): 91-6.
[PMID: 22456022]
[25]
Dange N, Redhu R, Kawale J, Mahore A. Primary amenorrhea due to empty sella: an underestimated entity. Turk Neurosurg 2012; 22(4): 499-501.
[PMID: 22843475]
[26]
Beressi N, Beressi JP, Cohen R, Modigliani E. Lymphocytic hypophysitis. A review of 145 cases. Ann Med Interne (Paris) 1999; 150(4): 327-41.
[PMID: 10519020]
[27]
Petersenn S, Quabbe HJ, Schöfl C, Stalla GK, von Werder K, Buchfelder M. The rational use of pituitary stimulation tests. Dtsch Arztebl Int 2010; 107(25): 437-43.
[http://dx.doi.org/10.3238/arztebl.2010.0437] [PMID: 20644702]
[28]
Colao A, Cotta OR, Ferone D, et al. Role of pituitary dysfunction on cardiovascular risk in primary empty sella patients. Clin Endocrinol (Oxf) 2013; 79(2): 211-6.
[http://dx.doi.org/10.1111/cen.12122] [PMID: 23215853]
[29]
Caplan RH, Dobben GD. Endocrine studies in patients with the “empty sella syndrome”. Arch Intern Med 1969; 123(6): 611-9.
[http://dx.doi.org/10.1001/archinte.1969.00300160001001] [PMID: 4181579]
[30]
Lupi I, Manetti L, Raffaelli V, et al. Pituitary autoimmunity is associated with hypopituitarism in patients with primary empty sella. J Endocrinol Invest 2011; 34(8): e240-4.
[PMID: 21623153]
[31]
Zuhur SS, Kuzu I, Ozturk FY, Uysal E, Altuntas Y. Anterior pituitary hormone deficiency in subjects with total and partial primary empty sella: do all cases need endocrinological evaluation? Turk Neurosurg 2014; 24(3): 374-9.
[http://dx.doi.org/10.5137/1019-5149.JTN.8671-13.0] [PMID: 24848177]
[32]
Grams AE, Gempt J, Stahl A, Förschler A. Female pituitary size in relation to age and hormonal factors. Neuroendocrinology 2010; 92(2): 128-32.
[http://dx.doi.org/10.1159/000314196] [PMID: 20523033]
[33]
Garner B, Berger GE, Nicolo JP, et al. Pituitary volume and early treatment response in drug-naïve first-episode psychosis patients. Schizophr Res 2009; 113(1): 65-71.
[http://dx.doi.org/10.1016/j.schres.2009.05.008] [PMID: 19515535]
[34]
Kaess M, Simmons JG, Whittle S, et al. Sex-specific prediction of hypothalamic-pituitary-adrenal axis activity by pituitary volume during adolescence: a longitudinal study from 12 to 17 years of age. Psychoneuroendocrinology 2013; 38(11): 2694-704.
[http://dx.doi.org/10.1016/j.psyneuen.2013.06.028] [PMID: 23906875]
[35]
Bozkurt Koseoglu S, Dinc Elibol F. Does the pituitary gland volume change in polycystic ovary syndrome? Gynecol Obstet Invest 2018; 83(5): 515-9.
[http://dx.doi.org/10.1159/000489495] [PMID: 29763897]
[36]
Fleckman AM, Schubart UK, Danziger A, Fleischer N. Empty sella of normal size in Sheehan’s syndrome. Am J Med 1983; 75(4): 585-91.
[http://dx.doi.org/10.1016/0002-9343(83)90437-0] [PMID: 6605088]
[37]
Terano T, Seya A, Tamura Y, Yoshida S, Hirayama T. Characteristics of the pituitary gland in elderly subjects from magnetic resonance images: relationship to pituitary hormone secretion. Clin Endocrinol (Oxf) 1996; 45(3): 273-9.
[http://dx.doi.org/10.1046/j.1365-2265.1996.00555.x] [PMID: 8949564]