Primary empty sella: differences and similarities between children and adults

Area of Science:

• Endocrinology
• Radiology
• Pediatrics

Background:

• Empty sella is a condition where the pituitary gland is not fully visible on MRI scans.
• Understanding the differences between pediatric and adult empty sella is crucial for diagnosis and treatment.

Purpose of the Study:

• To investigate potential differences in empty sella presentation and associated conditions between children and adults.
• To explore the relationship between empty sella and various pituitary disorders.

Main Methods:

• Retrospective study of 43 subjects (ages 4.1-27) with hypothalamic-pituitary disorders and empty sella on MRI.
• Evaluation of pituitary function, non-endocrine symptoms, perinatal history, sellar volume, pituitary height, and anatomical abnormalities.
• Categorization of subjects based on pituitary dysfunction: isolated growth hormone deficiency, multiple pituitary hormone deficiency, and puberty disorders.

Main Results:

• Multiple pituitary hormone deficiency was associated with a higher incidence of complete empty sella (pituitary height < 2 mm) and intrasellar abnormalities.
• Subjects with puberty disorders exhibited a larger mean sellar volume compared to other groups.
• Non-endocrine symptoms were infrequent, suggesting pituitary dysfunction is the primary manifestation.

Conclusions:

• The findings suggest a potentially congenital etiology for empty sella in pediatric subjects, distinct from adult presentations.
• Empty sella in children is frequently associated with pituitary dysfunction, including growth hormone deficiency and puberty disorders.
• Similar to adults, empty sella in children can be linked to both pituitary hypofunction and hyperfunction.