EMPTY SELLA: IT IS WORTH MENTIONING IN ROUTINE MR BRAIN IMAGING: A REVIEW OF 200 CASES FROM A TERTIARY CARE HOSPITAL.

RIZWAN AJMAL

EMPTY SELLA: IT IS WORTH MENTIONING IN ROUTINE MR BRAIN IMAGING: A REVIEW OF 200 CASES FROM A TERTIARY CARE HOSPITAL.

RIZWAN AJMAL

Abstract

ABSTRACT
BACKGROUND:
Primary empty sella (PES) is regarded as an incidental finding but there are several studies documenting the association of PES with clinical, hormonal and imaging abnormalities.
The primary empty sella (PES) or arachnoidocele is the herniation of subarachnoid space within the sella turcica in patients having no history of pituitary tumor, surgery, or radiotherapy.
MATERIAL AND METHODS:
This study is designed to retrospectively evaluate the selected variables including clinical features, biochemical endocrine functions and radiological imaging findings from the medical records of 200 patients with a diagnosis of PES on MR brain imaging.
RESULTS:
Out of 200 patients 41 (20.50%) were male and 159 (79.50%) were female. The mean age at the time of diagnosis was 56.87 years. In all the patients the diagnosis of PES was made by magnetic resonance imaging (MRI). In both the genders headache is the most prevalent symptom in our study seen in 67.5%. The second commonest association in male group is vertigo seen in 7.5% and obesity in female group seen in 28.5%. The third commonest association observed in male group found to be obesity in 6.5% and hypertension in female group seen in 26.5%. The least common association are ataxia and raised intracranial tension (ICT) seen only in 3% of cases.
CONCLUSION:
Primary empty sella is a condition ranging from asymptomatic population to patients with multiple clinical, neuroopthalmological and hormonal disorders. This wide range of variability reflect the diversity of its pathogenesis. Patients having severe intra-cranial tension (ICT), disabling headaches and severe visual disturbances should be evaluated for a potential neuro-surgical treatment. As our study is retrospective so no follow up data could be obtained. However due to risk of disease progression a regular radiological, endocrine and neuroopthalmological reassessment is recommended.
KEY WORDS
Primary empty sella (PES), Empty sella (ES), Magnetic resonance imaging, brain, arachnoidocele, headache.

Full Text:

PDF

References

REFERENCES:

Guitelman M, Basavilbaso NG, Vitale M, Chervin A, Katz D, Miragaya K, et al. Primary empty sella (PES): a review of 175 cases. Pituit. 2013;16(2):270-4.

De Marinis L, Bonadonna S, Bianchi A, Maira G, Giustina A. Primary empty sella. J Clinic Endocrinol Metab. 2005;90(9):5471-7.

Guinto G, Mercado M, Abdo M, Nishimura E, Aréchiga N, Nettel B. Primary empty sella syndrome. Contemp Neurosurg. 2007;29(11):1-6.

Davis S, Tress B, King J. Primary empty sella syndrome and benign intracranial hypertension. Clinic Exp Neurol. 1978;15:248-57.

Del Monte P, Foppiani L, Cafferata C, Marugo A, Bernasconi D. Primary" empty sella" in adults: endocrine findings. Endocr J. 2006:53(6):803-9.

Ghatnatti V, Sarma D, Saikia U. Empty sella syndrome–beyond being an incidental finding. Indian J Endocrinol Metab. 2012;16(2):321-3.

Rani PR, Maheshwari R, Reddy TK, Prasad NR, Reddy PA. Study of prevalence of endocrine abnormalities in primary empty sella. Indian J Endocrinol Metab. 2013;17(1):125-6.

Zagardo MT, Cail WS, Kelman SE, Rothman MI. Reversible empty sella in idiopathic intracranial hypertension: an indicator of successful therapy?. Am J Neuroradiol. 1996;17(10):1953-6.

Kim JH, Ko JH, Kim HW, Ha HG, Jung CK. Analysis of empty sella secondary to the brain tumors. J Korean Neurosurg Soc. 2009;46(4):355-9.

De Marinis L, Bonadonna S, Bianchi A, Maira G, Giustina A. Primary empty sella. J Clinic Endocrinol Metab. 2005;90(9):5471-7.

Foresti M, Guidali A, Susanna P. Primary empty sella. Incidence in 500 asymptomatic subjects examined with magnetic resonance. Radiol Med. 1991;81(6):803-7.

Bianconcini G, Bragagni G, Bianconcini M. Primary empty sella syndrome. Observations on 71 cases. Recent Prog Med. 1999;90(2):73-80.

Saindane AM, Lim PP, Aiken A, Chen Z, Hudgins PA. Factors determining the clinical significance of an “empty” sella turcica. Am J Roentgenol. 2013;200(5):1125-31.

Gallardo E, Schächter D, Caceres E, Becker P, Colin E, Martinez C, et al. The empty sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances. Clinic Endocrinol. 1992;37(6):529-33.

Maira G, Anile C, Mangiola A. Primary empty sella syndrome in a series of 142 patients. J Neurosurg. 2005;103(5):831-6.

Agarwal JK, Sahay RK, Bhadada SK, Reddy VS, Agarwal NK. Empty Sella Syndrome. J Indian Acad Clinic Med. 2001;2(3):198-201.

Kaufman B. The “empty” sella turcica, a manifestation of the intrasellar subarachnoid space. Radiol. 1968;90(5):931-41.

Sage MR, Blumbergs PC. Primary empty sella turcica: a radiological-anatomical correlation. Australas Radiol. 2000;44(3):341-8.

Gonzalez JG, Elizondo G, Saldivar D, Nanez H, Todd LE, Villarreal JZ. Pituitary gland growth during normal pregnancy: an in vivo study using magnetic resonance imaging. Am J Med. 1988;85(2):217-20.

Gallardo E, Schächter D, Caceres E, Becker P, Colin E, Martinez C. The empty sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances. Clinic Endocrinol. 1992;37(6):529-33.

Cannavo S, Curto L, Venturino M, Squadrito S, Almoto B, Narbone MC, et al. Abnormalities of hypothalamic-pituitary-thyroid axis in patients with primary empty sella. J Endocrinol Invest. 2002;25(3):236-9.

Sastre J, de la Morena Herranz L, Megía A, López AG, Gómez-Pan A, Pallardo LS. Primary empty sella turcica: clinical, radiological and hormonal evaluation. Rev Clin Esp. 1992;191(9):481-4.

Del Monte P, Foppiani L, Cafferata C, Marugo A, Bernasconi D. Primary" empty sella" in adults: endocrine findings. Endocr J. 2006:53(6):803-9

Necochea Y, Loja D, Aviles R, Vilca M. Silla turca vacía e hipopituitarismo. Revis Med Herediana. 1998;9(2):84-8.

De Marinis L, Mancini A, Giampietro A, Bianchi A, Tilaro L, Mangiola A, et al. The empty sella syndrome: general characteristics and neuroendocrine dynamics. Update in neuroendocrinology, from basic research to clinical practice. Pubblic Med Sci. 2004;2:291-320.

Gonzalez Tortosa. Primary empty sella: clinical, pathophysiology and treatment. Neurosurg. 2009;20(2):132-51.

Giustina A, Aimaretti G, Bondanelli M, Buzi F, Cannavò S, Cirillo S, et al. Primary empty sella: Why and when to investigate hypothalamic-pituitary function. J Endocrinol Invest. 2010;33(5):343-6.

Sivaraju L, Thakar S, Hegde AS. Visual deterioration and herniation of the anterior cerebral artery: Unusual presentation of an empty sella syndrome complicating decompression of a rathke cleft cyst. J Neuroophthalmol. 2016;36(2):156-8.

Auer MK, Stieg MR, Crispin A, Sievers C, Stalla GK, Kopczak A. Primary Empty Sella Syndrome and the Prevalence of Hormonal Dysregulation: A Systematic Review. Deutsch Ärzteblatt Int. 2018;115(7):99-105.

Debnath J, Ravikumar R, Sharma V, Senger KP, Maurya V, Singh G, et al. ‘Empty sella’on routine MRI studies: An incidental finding or otherwise?. Med J Arm Force India. 2016;72(1):33-7.

Chiloiro S, Giampietro A, Bianchi A, Tartaglione T, Capobianco A, Anile C, et al. Diagnosis of endocrine disease: primary empty sella: a comprehensive review. Europ J Endocrinol. 2017;177(6):275-85.

Kucharczyk W, Hazewinkel M. The sella turcica and parasellar region. Magnetic resonance imaging of the brain and spine. Radiol Assist. 1996;1:871-930.

Friedman TC, Zuckerbraun E, Lee ML, Kabil MS, Shahinian H. Dynamic pituitary MRI has high sensitivity and specificity for the diagnosis of mild Cushing's syndrome and should be part of the initial workup. Horm Metabol Resear. 2007;39(06):451-6.

Refbacks

There are currently no refbacks.