Empty Sella Syndrome: long-term impact on pituitary function

Empty Sella Syndrome (ESS) is characterized by a herniation of cerebrospinal fluid into the pituitary fossa, frequently causing pituitary dysfunction. Although ESS is generally asymptomatic, it can lead to progressive hormonal deficiencies. Long-term studies of pituitary function in patients with ESS are lacking. This study aimed to evaluate pituitary function in ESS patients, monitor the progression of hormone deficiencies, and explore the impact of gender, age, and body mass index (BMI). This is a descriptive and analytical study involving 41 patients diagnosed with ESS and treated at our university hospital between 2014 and 2024. All patients underwent MRI and endocrine testing for cortisol, thyrotropin, free thyroxine, prolactin, growth hormone, gonadal hormones, and testosterone. The median duration of follow-up was 5 years, with a range of 6 months to 10 years. Data was collected and analyzed using SPSS version 21. At diagnosis, 82.9% of patients had at least one pituitary hormone deficiency, primarily in the adrenal, gonadal, and growth hormone axes. Women were more likely to develop gonadal dysfunction (34.1%) than men (21.9%). A positive correlation between age and adrenal/gonadal insufficiency was observed. Additionally, a significant association was found between higher BMI and gonadal insufficiency, highlighting the role of obesity in exacerbating pituitary dysfunction. ESS is commonly linked to pituitary dysfunction, particularly in the adrenal and gonadal axes. Gender, age, and BMI influence the development and progression of hormonal deficiencies, underscoring the need for regular endocrine evaluation and long-term follow-up in these patients.