A parallel study of the roentgen anatomy of the sella turcica and the histopathology of the pituitary gland in 205 autopsy specimens.

To further elucidate to what extent minor sellar roentgenological changes imply the presence of a microadenoma or other histopathological findings in the pituitary gland, an autopsy series of 205 cases was investigated. Plain sellar films and multidirectional tomograms in frontal and lateral projections were obtained and the pituitary gland was histopathologically examined after being serial sectioned. Sloping of the sellar floor amounting to 2-14 degrees was found in 39 cases and minor cortical changes and configuration variations (locally thinner cortical layer, erosion and bulging) were seen in 23 cases. Histopathology revealed a solitary tumour in the anterior lobe in three cases and focal nodular hyperplasia in a fourth case. The diameter of these nonencapsulated 'adenomas' varied between 3 and 5 mm. Small cysts were a fairly common finding and fibrous tissue was present in about every second gland. No correlation was found between the roentgenological changes of the sella and histopathological findings in the gland. It was concluded that the type of roentgenological sellar findings described should be considered as normal variations without pathological significance when diagnosing a pituitary microadenoma.

Empty sella syndrome as complication of benign intracranial hypertension.

An empty sella was demonstrated on air study in five patients with the benign intracranial hypertension (BIH) syndrome. All patients had a protracted course and very high cerebrospinal fluid pressure; two required a shunt procedure. No patient had any endocrine symptoms or visual field defects but an air study was done to exclude a mass lesion in the sella region. Among the last 50 patients seen with the BIH syndrome, there were five cases of an associated empty sella (10%). In these cases, the empty sella is a probable consequence of the long-standing intracranial hypertension associated with a congenital deficiency of the diaphragma sellae.