ABSTRACT
Primary empty sella [ES] is an anatomo radiological picture. It is often asympotoniatic but it may be responsible for ophthalmological, neurological, or endocrinological disorders. To determine the incidence of empty sella in cases that seemed to have no endocrinopathy and to assess the neurological and hidden endocrinological manifestations. MRI of the brain and the pituitary was done for 500 cases. Hormonal analysis [serum cortisol, ACTH, LH, FSH, eostradiol, testosterone, FT4, TSH, GH, IGF] were measured. Empty Sella whether partial or complete was found in 135 cases [27%], it was reported more frequently in the elder age group who were above the age of 50, 32%, while the incidence for cases below 50 was 19%, P<0.01. Females had a higher tendency to develop ES 34%, whereas males 18%, P<0.05. Partial ES was more common than complete ES 17% [85/500] versus 10% [50/500] respectively but the difference was not statistically significant. Hundred and eleven cases out of 135 cases with ES and 72 control cases with normal sella turcica were available for reevaluation. They were subjected to a complete examination and hormonal studies. Neurological and endocrinological manifestations were more common in cases with ES than the control. Headache was the most common neurological complaint 50.5% [56/111], the majority had a complete ES 66%, papilloedema [2/111], visual field defect [2/111]. Hyperprolactinemia was the most common endocrinological manifestation 13.5% [15/111], followed by hypogonadotrophic hypogonadism 6.3%, panhypopiuitarism in 1.8%, secondary hypothyroid 0.9%, hypocorticotrophic 0.9%, low IGF1 and GH not responding to insulin stress test in 1.8%. Gigantism with features of acromegaly but with normal IGFI and GH was found in one young female. The percent of endocrinopathy was highly significant in patients with empty sella in comparison with the control cases who had normal sella. The odd ratio was 9.4, 95% confident interval [2.4-36]. An enlarged empty sella can be present without any symptoms and can be incidentally found by a CT or MRI. However neurological manifestations and endocrinopathies can be present and need management