Changes overtime in primary and secondary empty sella: a comparative real-world study.

Area of Science:

• Endocrinology
• Neuroimaging
• Pituitary Disorders

Background:

• Empty Sella (ES) encompasses Primary (PES) and Secondary (SES) types, often presenting similar radiological features but differing endocrine outcomes.
• Limited long-term comparative data exist for PES versus SES endocrine progression.

Purpose of the Study:

• To compare the baseline and longitudinal endocrine outcomes of Primary Empty Sella (PES) and Secondary Empty Sella (SES) in a large single-center cohort.
• To inform tailored follow-up strategies for patients with Empty Sella.

Main Methods:

• Retrospective, longitudinal study of adult ES patients at a tertiary endocrinology center (2007-2025).
• Classification of ES into PES or SES based on clinical history.
• Collection of clinical, neuroradiological, comorbidity, and serial pituitary hormonal data.

Main Results:

• 258 participants (64.3% female, median age 51.5 years, median follow-up 58.5 months).
• PES was more prevalent (61.6%) than SES (38.4%).
• Baseline pituitary deficiency was more common in SES (62.6%) vs. PES (27.7%), predominantly gonadotropic.
• PES showed stable pituitary function in 83.3% over time.
• SES demonstrated a higher risk of new corticotropic, thyrotropic, and gonadotropic deficiencies; arginine vasopressin deficiency occurred exclusively in SES.

Conclusions:

• PES and SES exhibit distinct endocrine trajectories.
• PES typically follows a stable course, whereas SES is associated with progressive pituitary dysfunction.
• Systematic baseline endocrine evaluation and closer surveillance for SES are recommended.