Endocrinological Differences Between Partial and Complete Primary Empty Sella: A Comparative Analysis

Empty sella is the herniation of the subarachnoid space into the sella turcica; either secondary to identifiable causes (e.g., surgery or radiotherapy); or spontaneously, which is termed primary empty sella (PES). The amount of cerebrospinal fluid (CSF) in the sella on imaging classifies PES as partial (<50% filling, pituitary >2 mm) or complete (≥50% filling, pituitary <2 mm). Few investigations have compared hormonal abnormalities in partial and complete PES.

This study aims to determine whether partial and complete PES differ endocrinologically.

Fifty-eight PES patients underwent hormonal evaluation: morning corticotropin (ACTH), cortisol, thyrotropin (TSH), free thyroxine (fT4), follicle‑stimulating hormone (FSH), luteinizing hormone (LH), estradiol (females), total testosterone (males), prolactin (PRL), growth hormone (GH) and insulin‑like growth factor‑1 (IGF‑1). Patients were divided into partial and complete PES groups and endocrinologically assessed.

The proportion of secondary adrenal insufficiency and secondary hypogonadism was significantly higher in the complete PES group (p = 0.021 and p = 0.041, respectively). The proportion of cases with two or more affected axes was higher in complete PES (p = 0.010). Secondary hypothyroidism was significantly more common among males (p = 0.001).

After a diagnosis of complete PES, clinicians should be cautious about secondary adrenal insufficiency and hypogonadism. It is advisable to perform hormonal testing for all PES patients, regardless of type, because affected‑axis rates often exceed 10% and may reach 50%. Prospective multicenter trials are necessary.