A comparison of pituitary function in primary and secondary empty sella: preliminary data

Background Empty sella (ES), the herniation of the subarachnoid space within sella associated with a variable flattening of the pituitary gland, is classified as primary (PES) or secondary (SES) on the basis of etiological factors. Aim To assess the differences between PES and SES in terms of pituitary function. Methods Clinical, radiological and hormonal data were retrospectively extrapolated from the records of 85 patients with a diagnosis of ES made between 1990 and 2016, attending to the Pituitary Unity of Azienda Ospedaliero-Universitaria of Modena, Italy. The pituitary function was assessed by basal hormonal measurements and dynamic tests in an appropriate clinical context. Chi square was used for comparison of categorical variables. Results Fifty-nine patients with PES (male/female ratio:1/2) and 26 with SES (male/female ratio:1.4/1) were considered. The mean age at diagnosis was 54G17 years in PES and 45G15 years in SES. Among PES 54% of patients had a normal pituitary function and 64% didn’t take replacement treatment, while in SES the percentages decreased to 28% and 35% respectively (Chi-squareZ16.8, P!0.0001). Accordingly, the overall number of pituitary deficits was higher in SES than in PES and even each single pituitary deficit occurred more frequently in SES (P!0.05). Mild hyperprolactinemia was present in 24% of PES and 22% of SES. A variable degree of hypopituitarism was found in 36% of PES and 58% of SES. Hypogonadism and growth hormone deficiency were the prevalent deficits among PES (61%) and SES (80%) respectively. The radiological degree of ES (partial vs total) didn’t influence the pituitary function. Discussion Our preliminary results confirm a higher prevalence of endocrine alterations in SES compared to PES but, in contrast with previous reports in literature, hypogonadism is the most frequent alteration in our PES patients. These data suggest that SES requires a more accurate endocrine screening and follow-up and, if confirmed by prospective studies, may open new insights on the management of ES.