Radiological features of PES and SES are generally similar. Therefore, we distinguish between a primary and secondary origin according to anamnestic data. ES is classified as primary empty sella (PES) when unrelated to any known pituitary disorder, and secondary empty sella (SES) when it results as a sequela of a pituitary injury, such as the spontaneous necrosis of a pituitary adenoma, an infective or autoimmune process or a previous surgical, pharmacological or radiotherapy treatment. The term “empty sella” (ES) refers to the herniation of the subarachnoid space within the sella turcica, with consequent flattening of the pituitary gland at its base ( 1). Patients need to be carefully evaluated at diagnosis, even if PES is incidentally discovered. Hypopituitarism is frequent (40%) but hormonal deterioration seems uncommon (3%). A progression from partial to total PES, which was found in 6/98 patients assessed with a second imaging, was the only parameter significantly related to the hormonal deterioration ( p=0.006).Ĭonclusions: this is the largest cohort of patients with PES reported. In 5/166 (3%), new deficiencies occurred, whereas 14/166 (8.4%) showed a hormonal recovery. A longitudinal assessment was possible in 166/402 (median follow-up=58 months). Hypopituitarism was associated with male sex ( p=0.02), suspected endocrinopathy ( p<0.001), traumatic brain injury ( p=0.003) and not with age, BMI, number of pregnancies and neuroradiological grade. Interestingly, hormonal alterations were diagnosed in 29% of incidental PES. Hypopituitarism was present in 40.5% (hypogonadism=20.4%, hypoadrenalism=14.7%, growth hormone deficiency=14.7%, hypothyroidism=10.2%, diabetes insipidus=1.5% multiple deficiencies=11.4%) and hypeprolactinemia in 6.5%. Results: we recruited 402 patients (females=63%, mean age=51.5 ± 16 years) with PES (partial, total, undefined in 66%, 13% and 21%, respectively). Methods: we analyzed hormonal (including basal and dynamic evaluations), clinical and neuroradiological data collected at diagnosis and at the last visit (at least 6 months of follow-up). Our aim was to evaluate the pituitary function of patients with PES over a long follow-up.ĭesign: multicenter retrospective cohort study enrolling patients referred between 1984-2020 to five Pituitary Units, with neuroradiological confirmed PES and a complete hormonal assessment. Objective: primary empty sella (PES) represents a frequent finding, but data on hormonal alterations are heterogeneous, and its natural history is still unclear. 9Niguarda Hospital, Division of Endocrinology, Milan, Italy.8IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy.
7Humanitas Gavazzeni, Endocrinologia, Bergamo, Italy.San Camillo Forlanini, Endocrinology Unit, Department of Oncology and Medical Specialities, Rome, Italy 5University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.4IRCCS Humanitas Research Hospital, Endocrinology, Diabetology and Andrology Unit, Rozzano, Italy.3Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.2Sapienza University of Rome, Department of Experimental Medicine, Rome, Italy.1Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy.Giulia Carosi 1,2 Alessandro Brunetti 3,4 Alessandra Mangone 1,5 Roberto Baldelli 6 Alberto Tresoldi 7 Giulia Del Sindaco 1,5 Elisabetta Lavezzi 4 Elisa Sala 1 Roberta Mungari 1 Letizia Maria Fatti 8 Elena Galazzi 8 Emanuele Ferrante 1 Rita Indirli 1,5 Emilia Biamonte 4 Maura Arosio 1,5 Renato Cozzi 9 Andrea Lania 3,4* Gherardo Mazziotti 3,4 Giovanna Mantovani 1,5
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