scholarly journals MRI Evaluation of Patients with Empty Sella - A Retrospective Study K.S. Hegde Medical Academy, Mangalore

2021 ◽  
Vol 10 (34) ◽  
pp. 2879-2883
Author(s):  
Mourish Asokan ◽  
Rohini Avantsa ◽  
Alan Anchan
Keyword(s):  
Retrospective Study ◽  
Intracranial Hypertension ◽  
Brain Imaging ◽  
Incidental Finding ◽  
Sella Turcica ◽  
Empty Sella ◽  
Mri Brain ◽  
Mri Features ◽  
Medical Academy ◽  
Centre Hospital

BACKGROUND Empty Sella is often an incidental finding in brain imaging studies. However, in the recent past, its association with hormonal and intracranial hypertension has been researched by various authors. The main purpose of the present study was to evaluate the MRI features of patients with empty sella presented for routine MRI brain imaging. METHODS This is a single-centre, hospital-based, observational, and retrospective study. MRI brain of 67 patients with empty sella was retrospectively reviewed from January 2012 to October 2020. All patients had been referred to the Department of Radiodiagnosis with clinical suspicion of intracranial pathology. The various manifestations and their complications were evaluated. RESULTS This present study comprised 39 males (58 %) and 28 females (42 %). The most common age group was 41 - 60 years with a mean age of 49 years. The most common presenting symptom was headache (34 %). In MRI brain study, 93 % of the cases of empty sella was an incidental finding. In 24 % of the patients, empty sella was associated with MRI features of intracranial hypertension and 13 % with idiopathic intracranial hypertension. 62.5 % of the patients with intracranial hypertension had complete empty sella compared to 82 % of the patients with no features of intracranial hypertension and had partial empty sella even though the association was not statistically significant. CONCLUSIONS The significance of the MRI finding of an empty sella turcica can be determined using a combination of clinical and imaging findings. KEY WORDS Empty Sella, MRI, Intracranial Hypertension.

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Sella Turcica ◽  
Radiographic Finding ◽  
Empty Sella ◽  
Senior Author ◽  
Csf Leak ◽  
Benign Intracranial Hypertension ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

scholarly journals Anterior Hypopituitarism and Treatment Response in Hunter Syndrome: A Comparison of Two Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Munier A. Nour ◽  
Paola Luca ◽  
David Stephure ◽  
Xing-Chang Wei ◽  
Aneal Khan
Keyword(s):  
Growth Velocity ◽  
Incidental Finding ◽  
Final Height ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Clinical Importance ◽  
Hunter Syndrome ◽  
Empty Sella ◽  
Gh Treatment ◽  
Poor Growth

Hypopituitarism is a clinically important diagnosis and has not previously been reported in Hunter syndrome. We contrast two cases with anatomic pituitary anomalies: one with anterior panhypopituitarism and the other with intact pituitary function. Patient 1, a 10-year-old boy with Hunter syndrome, was evaluated for poor growth and an ectopic posterior pituitary gland. Endocrine testing revealed growth hormone (GH) deficiency, secondary adrenal insufficiency, and tertiary hypothyroidism. An improvement in growth velocity with hormone replacement (GH, thyroxine, and corticosteroid) was seen; however, final adult height remained compromised. Patient 2, a 13-year-old male with Hunter syndrome, was evaluated for growth failure. He had a large empty sella turcica with posteriorly displaced pituitary. Functional endocrine testing was normal and a trial of GH-treatment yielded no significant effect. Panhypopituitarism associated with pituitary anomalies has not been previously reported in Hunter syndrome and was an incidental finding of significant clinical importance. In the setting of documented anterior hypopituitarism, while hormone replacement improved growth velocity, final height remained impaired. In patient 2 with equivocal GH-testing results, treatment had no effect on linear growth. These cases highlight the importance of careful clinical assessment in Hunter syndrome and that judicious hormone replacement may be indicated in individual cases.

Spontaneous Nasal Cerebrospinal Fluid Leaks and Empty Sella Syndrome: A Clinical Association

2003 ◽  
Vol 17 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Skull Base ◽  
Sella Turcica ◽  
Empty Sella ◽  
Radiographic Appearance ◽  
Radiographic Findings ◽  
Empty Sella Syndrome ◽  
Csf Pressure ◽  
Csf Leaks

Background Spontaneous, idiopathic nasal meningoencephaloceles are herniations of arachnoid/dura and cerebrospinal fluid (CSF) through anatomically fragile sites within the skull base. Empty sella syndrome occurs when intracranial contents herniate through the sellar diaphragm filling the sella turcica with CSF and giving the radiographic appearance of an absent pituitary gland. The objective of this study was to examine the association between spontaneous encephaloceles/CSF leaks and empty sella syndrome because of their similar clinical features and potential common pathophysiology. Methods Retrospective. Results Sixteen patients were treated for spontaneous encephaloceles between 1996 and 2001. All 16 patients had associated CSF leaks. Five patients had multiple simultaneous encephaloceles. Fifteen patients with imaging of the sella turcica had empty (10 patients) or partially empty (5 patients) sellas. One patient did not have complete imaging of the sella. Three patients had lumbar punctures with measurement of CSF pressure during computed tomography cisternograms because of multiple skull base defects. Mean CSF pressure was 28.3 cm of water (range, 19–34 cm; normal, 0–15 cm). Thirteen of 16 patients (81%) were obese women (mean body mass index, 35.9 kg/m2; normal, <25 kg/m2). Mean follow-up was 14.2 months with 100% success in closure of the defects after one procedure. Conclusion Spontaneous meningoencephaloceles and CSF leaks are strongly associated with radiographic findings of an empty sella and suggest a common pathophysiology. The underlying condition probably represents a form of intracranial hypertension that exerts hydrostatic pressure at anatomically weakened sites within the skull base. Otolaryngologists should be familiar with this disease entity and the implications intracranial hypertension has on patient management.

scholarly journals Acute HIV Infection Masquerading as Idiopathic Intracranial Hypertension: A Case Report and Literature Review

2020 ◽  
Vol 12 (1) ◽  
pp. 56-62
Author(s):  
Awyshah M. Alqahtani ◽  
Zaid F. Alsaaran ◽  
Naif H. AlOtaibi ◽  
Mazin Barry ◽  
Khaldoon AlJerian ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sella Turcica ◽  
Signs And Symptoms ◽  
Empty Sella ◽  
Acute Hiv Infection ◽  
Csf Analysis ◽  
Hiv Antigen ◽  
Acute Hiv ◽  
Antigen Antibody

We describe a previously healthy 21-year-old man who presented acutely with signs and symptoms of raised intracranial pressure (ICP). Lumbar puncture yielded an elevated opening pressure and an acellular CSF analysis. Radiological images showed bilateral flattening of the posterior eye globes and an empty sella turcica. His serum HIV antigen/antibody was reactive. We provide a review of published cases that have been labeled as idiopathic intracranial hypertension (IIH) in HIV-infected patients, addressing the appropriateness of labeling such cases as truly idiopathic. We also discuss the importance of a thorough clinical evaluation of raised ICP in those who do not fulfil the typical IIH demographic.

scholarly journals Empty sella syndrome presenting as panhypopituitarism in a child

2016 ◽  
Vol 6 (1) ◽  
pp. 58
Author(s):  
Sharmin Jahan ◽  
Masfiq-Ul- Hasant ◽  
Nusrat Sultana ◽  
Md. Fariduddin ◽  
Mohammad Enayet Hussain ◽  
...  
Keyword(s):  
Wrist Joint ◽  
Incidental Finding ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Bone Age ◽  
Empty Sella ◽  
Response To Treatment ◽  
Growth Hormone Replacement Therapy ◽  
Radiologic Imaging

Empty Sella refers to the absence or relative absence of the pituitary gland on radiologic imaging of the Sella turcica. This is usually an incidental finding, and as few as 10% patients presents with Hypopituitarism. The authors report a 13.5-year-old boy who presei1ted with short stature and absence of signs of pubertal onset. Hormonal assay showed panhypopi­tuitarism. X-ray left wrist joint showed delayed bone age and finally MRl of the brain revealed empty Sella. Growth hormone replacement therapy was started to increase the height. The boy is now on regular follow up to monitor response to treatment.

The potentials of magnetic resonance tomography in the diagnosis of the “empty” sella turcica

1994 ◽  
Vol 24 (3) ◽  
pp. 229-233 ◽  
Author(s):  
I. I. Dedov ◽  
T. S. Zenkova ◽  
G. A. Mel'nichenko ◽  
O. I. Belichenko ◽  
I. D. Fedina
Keyword(s):  
Magnetic Resonance ◽  
Sella Turcica ◽  
Magnetic Resonance Tomography ◽  
Empty Sella

THE PRIMARY EMPTY SELLA AN ENDOCRINE STUDY ON 12 CASES

1976 ◽  
Vol 83 (3) ◽  
pp. 483-492 ◽  
Author(s):  
G. Schaison ◽  
J. Metzger
Keyword(s):  
Prolactin Level ◽  
Sella Turcica ◽  
Empty Sella ◽  
Endocrine Function ◽  
Thyrotrophin Releasing Hormone ◽  
Releasing Hormone ◽  
Group A ◽  
Group B ◽  
Lh Releasing Hormone ◽  
Primary Empty Sella

ABSTRACT Twelve patients (10 women and 2 men) with a primary empty sella turcica were studied. Endocrine function tests were performed as follows: growth hormone (GH) was measured after insulin-induced-hypoglycaemia, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) after LH-releasing hormone, thyrotrophin (TSH) and prolactin after thyrotrophin-releasing hormone; pituitary reserve of adrenocorticotrophin (ACTH) was determined by measurement of plasma cortisol after lysinevasopressin and 11 deoxycortisol after metyrapone. Five of the patients (group A) had no endocrine disturbance. Seven patients (group B) had a hypothalamo-pituitary disorder. Two of them had panhypopituitarism which appeared in one case after meningoencephalitis and in the other after a severe cranial trauma. In two cases an amenorrhoea-galactorrhoea syndrome with increased prolactin level (68 and 230 ng/ml) led to a diagnosis of a prolactin producing adenoma, which was confirmed by surgery. Finally three cases of amenorrhoeagalactorrhoea, with normal prolactin level, and/or diabetes insipidus remained unexplained. However, no causal relationship could be demonstrated between the pituitary disturbance and the "empty sella". Primary empty sella turcica is therefore a neuroanatomical and neuroradiological entity with no endocrine implication. A pituitary disorder might suggest a microadenoma or an incidentally associated disease.

scholarly journals Anterior pituitary lobe atrophy as late complication of hemorrhagic fever with renal syndrome

2009 ◽  
Vol 66 (2) ◽  
pp. 166-168
Author(s):  
Dragan Jovanovic ◽  
Zoran Kovacevic ◽  
Tamara Dragovic ◽  
Marijana Petrovic ◽  
Jelena Tadic
Keyword(s):  
Renal Insufficiency ◽  
Anterior Pituitary ◽  
Late Complication ◽  
Sella Turcica ◽  
Hemorrhagic Fever ◽  
Empty Sella ◽  
Acute Stage ◽  
Hantavirus Infection ◽  
Multisystemic Disease ◽  
Acute Renal Insufficiency

Introduction. Hemorrhagic fever with renal syndrome (HFRS) is acute infective multisystemic disease followed by febrility, hemorrhages and acute renal insufficiency. Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of HFRS, while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. Case report. We presented a patient with the development of chronic renal insufficiency and hypopituitarism as complication that had been diagnosed six years after Hantavirus infection. Magnetic resonance of the pituitary gland revealed atrophy and empty sella turcica. Conclusion. Regarding frequency of this viral infection and its endemic character in some parts of our country partial and/or complete loss of pituitary function should be considered during the late stage of HFRS.

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