Computed tomography for diagnosis of empty sella associated with enhancing pituitary microadenoma

Ten cases of primary empty sella with clinical findings of a secreting pituitary adenoma were studied using computed tomography (CT). Scans performed before contrast medium infusion confirmed the diagnosis of empty sella. After infusion, eight cases were found to have a nodular area of increased density within the sella turcica. In two patients, the enhancement probably corresponded to the pituitary stalk; the other six patients demonstrated CT evidence of pituitary microadenoma. These six patients had surgical confirmation of the existence of neoplasm. Tomodensitometric diagnosis of empty sella combined with microadenoma allows transsphenoidal microsurgery for complete tumor removal with preservation of the residual pituitary gland. For comparison, in a series of 21 patients suspected of having microadenomas, but without evidence of empty or enlarged sella, enhancing microadenomas were shown in 13 (62%).