Empty Sella and Cushing's Disease: Lessons Learned from a Diagnostically Challenging Case.

Area of Science:

• Endocrinology
• Neuroimaging
• Oncology

Background:

• Pituitary adenomas are the main cause of Cushing's disease (CD).
• Empty sella syndrome can lead to negative MRI findings in patients with pituitary adenomas, complicating CD diagnosis.
• This case highlights overcoming diagnostic challenges in CD with coexisting empty sella.

Purpose of the Study:

• To illustrate how advanced imaging and endocrine testing can diagnose Cushing's disease in the presence of empty sella syndrome.
• To emphasize the importance of comprehensive diagnostic approaches for pituitary adenomas.

Main Methods:

• A 54-year-old woman presented with symptoms suggestive of CD.
• Initial MRI showed an empty sella, but endocrine tests indicated CD.
• Bilateral inferior petrosal sinus sampling and high-resolution dynamic enhanced MRI identified pituitary nodules.

Main Results:

• Despite an initial empty sella finding on MRI, pituitary nodules were detected using advanced imaging techniques.
• The patient underwent successful surgical treatment with favorable postoperative outcomes.
• Endocrine function tests and advanced imaging were pivotal in diagnosing CD.

Conclusions:

• The presence of empty sella does not rule out Cushing's disease.
• Standardized endocrine tests and advanced imaging are essential for diagnosing CD.
• Clinical reasoning is vital in managing complex pituitary adenoma cases.