Empty Sella Syndrome: long-term impact on pituitary function

Area of Science:

• Endocrinology
• Neuroimaging
• Internal Medicine

Background:

• Empty Sella Syndrome (ESS) involves cerebrospinal fluid herniation into the pituitary fossa, potentially leading to pituitary dysfunction.
• While often asymptomatic, ESS can cause progressive hormonal deficiencies, yet long-term studies are scarce.

Purpose of the Study:

• To evaluate pituitary function in ESS patients.
• To monitor the progression of hormone deficiencies over time.
• To explore the influence of gender, age, and BMI on pituitary function in ESS.

Main Methods:

• A descriptive and analytical study of 41 ESS patients treated between 2014 and 2024.
• Utilized MRI and comprehensive endocrine testing (cortisol, TSH, fT4, prolactin, GH, gonadal hormones, testosterone).
• Median follow-up of 5 years (range: 6 months to 10 years), with data analyzed using SPSS v.21.

Main Results:

• 82.9% of patients presented with at least one pituitary hormone deficiency at diagnosis, mainly affecting adrenal, gonadal, and growth hormone axes.
• Women showed a higher incidence of gonadal dysfunction (34.1%) compared to men (21.9%).
• Age correlated positively with adrenal/gonadal insufficiency, and higher BMI was significantly associated with gonadal insufficiency.

Conclusions:

• ESS is frequently associated with pituitary dysfunction, especially in the adrenal and gonadal axes.
• Gender, age, and BMI are significant factors influencing the development and progression of hormonal deficiencies in ESS patients.
• Regular endocrine evaluation and long-term follow-up are crucial for managing patients with ESS.