SEVERE ANTERIOR HYPOPITUITARISM – RARE PRESENTATION OF PRIMARY EMPTY SELLA SYNDROME

Abstract

The term “primary empty sella” (PES) refers to a neuroradiological entity characterized by a cerebrospinal fluid (CSF) filled sella, with a small pituitary gland compressed to the rim of the fossa. While its aetiology is not completely clear, it is currently being viewed as related to the mechanical transmission of the CSF pressure through an incomplete sellar diaphragm [1, 2]. PES has been reported in 6-20 % of unselected autopsies [1]. PES is also a frequent incidental finding due to widespread use of computerized tomography (CT) and magnetic resonance imaging (MRI) techniques. More rarely, PES patients present with CSF rhinorrhoea, visual field defects or papilloedema [3]. Global hypopituitarism is thought to be rare in PES [5, 6]. Hyperprolactinaemia due to distortion of pituitary stalk is present in about 10% of cases [7]. GH is the most frequently affected hormone and few recent studies have demonstrated a decreased pituitary GH reserve in 35-60% of adult PES subjects [5, 8].