clinical impact of the radiological diagnosis of primary empty sella

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

Multiparity as a risk factor inducing pituitary function failure in the elderly

Hypopituitarism is difficult to diagnose in eldery people. The presentation usually are non specific with symptoms such as lethargy, pallor, falls, urinary incontinence, confusion, fever and even coma. Hormone replacement therapy resulted in improving quality of life [1,2]. Physicians dealing with elderly patients should bear this easily treated condition in mind. Prompted by striking features in four females, all over 60 years admitted to ourhospital with unexplained lethargy, altered state of consciousness and loss or diminished pubic hair with normal obstetric history but gravida more than 7. Pituitary assessment was done which proved hypopituitarism in all the 4 cases. This attracts our attention to study the relation between multiparity and pituitary dysfunction. Patients and methods: This study was a semiprospective study, over 7 years between June1992 till April 2000. The study included 22 female patients, age between 60-79 years with parity ranged from 4-13 with the majority of cases [91%] have parity more than 5. The control group included 20 females of same age group but nullipara or have one parity only. All were admitted to the hospital due to unexplained lethargy, generalized weakness and altered sensorium. Endocrine disturbance was clinically suspected. Thorough physical examination and history was taking emphasizing on the obstetric history. Hormonal assay [RIA], LH, FSH, estradiol, cortisol, TSH, T3, FT4, ACTH and prolactin were measured, 800am along with Na and k.CT brain and /or MRI were done for pituitary glands. Hormonal assay showed statistically low mean level of LH, FSH in the multiparous group compared to the control group [P<0.01]. TSH was normal in both groups, while T3, FT4, estradiol and cortisol were slightly lower than the control but the difference was not statistically significant except for estradiol and cortisol. Similar results were found as regards ACTH and prolactin. MRI showed empty sella in the majority of multiparous group 15 cases [68%], while only in 5 cases [25%] of the control group. The difference was significant. Final clinical diagnosis, showed definite pituitary dysfunction in majority of multiparous group, 12 cases had hypogonadotrophine associated with secondary hypothyroid in 4 cases, or with secondary hypoadrenalism in 4 cases, three cases have hypopituitarism, one case with hyperprolactinemia and two cases with SIADH syndrome and three cases have normal hormonal assay in spite of some clinical signs suggesting hormonal deficiency. Control group had much less hormonal disturbance, only one case has hypogonadotrophine, one case has hyperprolactinemia and one case with primary hypothyroid. We found definite relation between number of parity and pituitary dysfunction, the risk ratio was 4.1, [95% CI 1.7-9.5]. We recommend that physician dealing with elderly patients should consider the possibility of hypopituitarism in ill elderly grand multipara female patients, when no obvious diagnosis can explain their conditions, especially if signs of hormonal disturbance were detected as absent or diminisihed pubic hair, pallor and buffy face. Hormonal study must done for these patients