Primary empty sella: Why and when to investigate hypothalamic-pituitary function

Empty sella (ES) is defined as an herniation of the subarachnoid space into the sella turcica, which is associated with stretching of the pituitary stalk and flattening of pituitary gland against the sellar floor. The compression of the pituitary gland and/or the pituitary stalk can cause insufficient function of the gland as well as hyperprolactinemia. In the literature, global hypopituitarism has been thought to be rare (about 2% of the patients with primary empty sella, PES). GH deficiency is apparently the most frequent hormone deficiency described in PES. In a small number of patients, a reduction in gonadotropin release with either pituitary or hypothalamic origin has been observed . As well, isolated deficiencies of ACTH, TSH, and antidiuretic hormone have been occasionally described. PES should not be considered as merely an incidental finding and clinicians should be aware of its varying presentations and ramifications