'Empty sella' on routine MRI studies: An incidental finding or otherwise?

Area of Science:

• Neuroimaging
• Endocrinology
• Neurology

Background:

• Empty sella (ES) was traditionally considered an incidental radiological finding.
• Emerging evidence suggests associations between ES and various hormonal and non-hormonal abnormalities.
• Understanding the prevalence and associated conditions of ES is crucial for comprehensive patient care.

Purpose of the Study:

• To determine the prevalence of empty sella (ES) in routine MRI brain studies.
• To investigate the association between ES and specific clinical conditions, including hormonal and neurological abnormalities.
• To compare the occurrence of these conditions in patients with ES versus the general population.

Main Methods:

• A retrospective analysis of 12,414 MRI brain studies was conducted.
• Patients with ES (n=241) formed the study group; others comprised the baseline population.
• Statistical analysis, including Chi-square tests, was used to assess associations between ES and nine variables: hormonal disturbances, headache, sensorineural hearing loss, seizures, vertigo, psychiatric disorders, visual disturbances, ataxia, and raised intracranial tension.

Main Results:

• The prevalence of ES was found to be 1.94% (241 out of 12,414 patients).
• Significantly higher proportions of patients with ES exhibited hormonal disturbances (3.31% vs 0.56%), sensorineural hearing loss (3.7% vs 1.3%), vertigo (4.6% vs 1.6%), psychiatric disorders (4.6% vs 1.3%), and raised intracranial tension (2% vs 0.5%) compared to the non-ES group.
• Seizures were less common in the ES group (6.2% vs 13%).

Conclusions:

• Hormonal disturbances, psychiatric disorders, raised intracranial tension, and sensorineural hearing loss are significantly more prevalent in individuals with empty sella.
• These findings challenge the view of ES as merely an incidental finding, highlighting its potential association with specific pathologies.
• Further research is warranted to elucidate the underlying mechanisms connecting ES and these associated conditions.