Empty Sella and Pituitary Gland

1978 ◽  
pp. 38-38
Author(s):  
J. L. Dietemann ◽  
A. Wackenheim
Keyword(s):  
Pituitary Gland ◽  
Empty Sella

scholarly journals Primary Empty Sella Syndrome: A Case Report

1970 ◽  
Vol 1 (1) ◽  
pp. 23-25
Author(s):  
Md Sanwar Hossain ◽  
Mahbuba Ashrafi Mumu ◽  
Md Moyenuddin PK
Keyword(s):  
Case Report ◽  
Pituitary Gland ◽  
Subarachnoid Space ◽  
Empty Sella ◽  
Multiple Pregnancies ◽  
Empty Sella Syndrome ◽  
Ocular Abnormalities ◽  
Medical College ◽  
Persistent Headache ◽  
Primary Empty Sella

Primary Empty Sella Syndrome (PES) is a relatively rare or uncommon developmental disease that develops spontaneously. It is characterized by herniation of subarachnoid space within the sella which is often associated with some degree of flattening of pituitary gland. Usually manifested by endocrine abnormalities, ocular abnormalities, rhinitis and intractable persistent headache. It is higher in obese females having multiple pregnancies. Here we report a case of empty sella syndrome in a 27 year old lady to aware the physicians to bear in mind a differential in patients having persistent intractable headache. Key words: Empty Sella Syndrome; Woman; Obesity; Intractable Headache DOI: 10.3329/akmmcj.v1i1.7456 Anwer Khan Modern Medical College Journal 2010; 1(1): 23-25

Syndrome of inappropriate secretion of ADH after administration of intrathecal chemotherapy in acute promyelocytic leukemia with empty sella of pituitary gland

2006 ◽  
Vol 86 (2) ◽  
pp. 149-150 ◽  
Author(s):  
Yutaka Tsutsumi ◽  
Takahito Kawamura ◽  
Souichi Shiratori ◽  
Shinobu Mashiko ◽  
Makoto Ibata ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Acute Promyelocytic Leukemia ◽  
Intrathecal Chemotherapy ◽  
Empty Sella ◽  
Promyelocytic Leukemia ◽  
Inappropriate Secretion

scholarly journals MON-294 T2 MRI Signal Analysis of The Pituitary Gland Is Efficient in the Diagnosis of Acromegaly Due to GHRH Ectopic Secretion

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jean Francois Bonneville ◽  
Julia Potorac ◽  
Vincent Rohmer ◽  
Adrian F Daly ◽  
Albert M Beckers
Keyword(s):  
Pituitary Gland ◽  
Neuroendocrine Tumor ◽  
Correct Diagnosis ◽  
Empty Sella ◽  
Bronchial Carcinoid ◽  
Pituitary Mass ◽  
Ectopic Secretion ◽  
Pituitary Hyperplasia ◽  
T2 Mri ◽  
Ectopic Acromegaly

Abstract Less than 1% of cases of acromegaly are secondary to ectopic secretion of Growth Hormone Releasing Hormone (GHRH), usually from a neuroendocrine tumor. Symptoms of ectopic acromegaly did not differ from classical acromegaly from pituitary origin. GH and IGF 1 values are in the same range. GHRH measurement only could make the correct diagnosis but is not routinely proposed in acromegaly. MRI of the pituitary gland is considered not very effective in ectopic acromegaly. In the literature (1), different patterns are described: pituitary enlargement (46%), adenoma (30%), empty sella (2%) or normal (20%). But T2MRI signal of the pituitary is never mentioned nor illustrated. Finally, in about 30 % of published cases, pituitary surgery, of course inefficient, was performed. These data enhance the poor contribution of imaging studies in the published cases of ectopic acromegaly. We have been able to obtain and read MRIs and particularly T2WI of 27 acromegalic patients- 20 female, 7 male- due to GHRH hypersecretion from a neuroendocrine tumor –principally bronchial carcinoid and pancreatic NET- which have been published or not. Remarquably, T2 sequences were available in only 27/61 cases we have collected. In all these 27 cases but two, the T2 signal was clearly hypointense if compared with the brain cortex, as it has been described in densely granulomated somatotropinomas (2). In one case with T2 hyperintensity, the pituitary mass presented the same imaging characters as multiple brain metastases from a bronchial carcinoïd. In one case, T2 signal was isointense. In 3 cases, tiny millimetric T2 hyperintense images were disseminated within pituitary hyperplasia. In several cases where pituitary MRI was considered as normal, correlation of the patient’age with pituitary size could make suspect an enlarged gland. In a case labeled empty sella, T2MRI signal of the pituitary remnant was hypointense. When coupling T2 and T1 gadolinium enhanced sequences, no pituitary adenoma was visualized and normal pituitary tissue was never identified along with pituitary hyperplasia. In conclusion, T2 MRI hypointense signal of the pituitary gland is a better hallmark than pituitary hyperplasia for the diagnosis of acromegaly due to GHRH ectopic secretion. Analysis of T2 MR signal in these cases is essential to avoid unnecessary interventions to the pituitary. References 1 Ghazi A Endocrine 2013 2 Potorac J Endocr Relat Cancer 2015

scholarly journals Empty Sella Prevalence: Step By Step

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Victoria B. Sharavii ◽  
Natalya A. Shnayder ◽  
Lada K. Sharavii ◽  
Marina M. Petrova ◽  
Regina F. Nasyrova
Keyword(s):  
Pituitary Gland ◽  
Subarachnoid Space ◽  
Sella Turcica ◽  
Empty Sella ◽  
Systematic Search ◽  
Pituitary Fossa ◽  
The World

An empty sella (ES), also known as an empty sella turcica (empty pituitary fossa) is defined as an intrasellar herniation of subarachnoid space within the sella which leads to flattening of the pituitary gland towards the posteroinferior wall. Purpose — to analyze studies of ES prevalence in the world. Methods — We carried out a systematic search in both Russian and English databases (E-library, PubMed, GoogleScholar, OxfordPress, ClinicalKeys) using keywords “empty sella”, “empty sella turcica”, “empty pituitary fossa”, “prevalence” and their combinations. The period of search: 2000-2020. It is also worth noting that earlier publications of historical interest were included in the review. Results — We have analyzed 23 studies. They can be roughly devided into two groups: the first group – screening studies of ES, the second group – targeted studies of ES.

scholarly journals Extrapituitary Parasellar Microadenoma in Cushing’s Disease

1999 ◽  
Vol 84 (8) ◽  
pp. 2912-2923 ◽  
Author(s):  
Ryszard M. Pluta ◽  
Lynnette Nieman ◽  
John L. Doppman ◽  
Joseph C. Watson ◽  
Nancy Tresser ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Cushing’S Disease ◽  
Anterior Lobe ◽  
Empty Sella ◽  
Cushing's Disease ◽  
Pars Tuberalis ◽  
Serial Sections ◽  
Resonance Imaging ◽  
High Incidence ◽  
Acth Secreting

Negative sellar exploration (despite the results of endocrine evaluation indicating Cushing’s disease), the high incidence of failure of total hypophysectomy, and remission of Cushing’s syndrome after unsuccessful hypophysectomy and sellar irradiation suggest that the etiology of refractory Cushing’s disease, in some patients, lies near the sella but not in the pituitary gland. We present 5 patients, out of 626 who received surgery for Cushing’s disease, in whom an ACTH-secreting extrapituitary parasellar adenoma was identified: 2 after unsuccessful total hypophysectomy for the treatment of refractory Cushing’s disease, 2 after unsuccessful hemihypophysectomy (the first, 2 yr before treatment at the NIH for Nelson’s syndrome; and the second, with recurrent Cushing’s disease 5 yr after negative transsphenoidal exploration), and 1 with a preoperative diagnosis of an intraclival microadenoma, which was cured by resection of the tumor. In all cases, an extrapituitary parasellar microadenoma was confirmed unequivocally as the cause of the disease, by negative pathology of the resected pituitary gland (patients 1, 2, 3, and 5), and/or the remission of the disease after selective resection of the extrasellar adenoma (patients 3, 4, and 5). Three of 5 patients had a partial empty sella. These patients support the thesis that ACTH-secreting tumors can arise exclusively from remnants of Rathke’s pouch, rather than from the adenohypophysis (anterior lobe or pars tuberalis of the pituitary gland) and can be a cause of Cushing’s disease. In the sixth presented case, an extrapituitary tumor was suspected at surgery after negative pituitary exploration, but serial sections of the hemihypophysectomy specimen revealed a microscopic focus of tumor at the margin of the resected gland. This case demonstrates the importance of negative pituitary histology to establish the presence of an extrapituitary parasellar tumor as an exclusive source of ACTH, and it supports the value of clinical outcome to establish the diagnosis with selective adenomectomy of an extrapituitary parasellar tumor. In patients with negative pituitary magnetic resonance imaging, especially in the presence of a partial empty sella, the diagnostic and surgical approach in Cushing’s disease should consider the identification and resection of extrapituitary parasellar adenoma, which can avoid total hypophysectomy, as was possible in 3 of our 5 patients.

Effect of primary empty sella syndrome on pituitary surgery for Cushing's disease

2014 ◽  
Vol 121 (3) ◽  
pp. 518-526 ◽  
Author(s):  
Gautam U. Mehta ◽  
Kamran D. Bakhtian ◽  
Edward H. Oldfield
Keyword(s):  
Pituitary Gland ◽  
Cushing’S Disease ◽  
Pituitary Surgery ◽  
Empty Sella ◽  
Cushing's Disease ◽  
Csf Leak ◽  
Empty Sella Syndrome ◽  
Csf Leaks ◽  
Primary Empty Sella

Object Primary empty sella syndrome (ESS) results from herniation of arachnoid mater into the pituitary fossa. It has been suggested to have a negative effect on pituitary surgery; however, outcomes in this cohort have not been defined. This study was performed to determine the effect of ESS on immediate and long-term biochemical outcome after pituitary surgery for Cushing's disease (CD). Methods Using a matched cohort study design, the authors followed patients treated with pituitary surgery for CD with and without ESS. Complete ESS was defined as pituitary gland height ≤ 2 mm, whereas partial ESS was defined as pituitary gland height > 2 mm but less than three-quarters of the total sellar depth. The primary end points were immediate and long-term biochemical outcome. Cerebrospinal fluid leaks were recorded as a secondary end point. Results Seventy-eight patients with CD and primary ESS were identified and matched with 78 patients with CD without ESS. After surgical management, immediate biochemical remission was achieved in 69 patients (88%) with ESS and 75 controls (96%, p = 0.10). Long-term remission was achieved in most patients in both groups (5-year cure: 85% vs 92%, p = 0.10). Among patients with ESS, the presence of complete ESS predicted a worse long-term outcome (p = 0.04). Intraoperative CSF leaks were significantly more frequent with ESS (54% vs 24%, p < 0.001), and despite sellar floor repair, the rate of postoperative CSF leaks was also increased (6% vs 3%, p = 0.27). Conclusions Biochemical outcome after pituitary surgery for CD was worse in patients with complete ESS, and the risk of a CSF leak was increased with both partial and complete ESS. However, as outcome remains superior to those following alternative therapies and the biology of these tumors is unchanged in the setting of ESS, pituitary surgery should remain the initial treatment of choice.

scholarly journals Does pituitary compression/empty sella syndrome contribute to MRI-negative Cushing’s disease? A single-institution experience

2020 ◽  
Vol 48 (6) ◽  
pp. E3
Author(s):  
Benjamin T. Himes ◽  
Adip G. Bhargav ◽  
Desmond A. Brown ◽  
Timothy J. Kaufmann ◽  
Irina Bancos ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Cushing’S Disease ◽  
Adrenocorticotropic Hormone ◽  
Empty Sella ◽  
Cushing's Disease ◽  
Relative Reduction ◽  
Single Institution ◽  
Empty Sella Syndrome ◽  
Tissue Diagnosis ◽  
Acth Secreting

OBJECTIVECushing’s disease arises from functioning adrenocorticotropic hormone (ACTH)–secreting pituitary adenomas. These tumors can be very small and evade detection by MRI. Empty sella syndrome is a phenomenon by which an arachnoid outpouching of CSF into the sella leads to compression of the pituitary, likely due to intracranial hypertension (a common issue in Cushing’s disease), further leading to difficulty in visualizing the pituitary gland that may contribute to difficulty in finding a tumor on MRI, so-called MRI-negative Cushing’s disease. The authors sought to examine the association between empty sella syndrome and MRI-negative Cushing’s disease.METHODSA single-institution database of Cushing’s disease cases from 2000 to 2017 was reviewed, and 197 cases were included in the analysis. One hundred eighty patients had a tissue diagnosis of Cushing’s disease and 17 had remission with surgery, but no definitive tissue diagnosis was obtained. Macroadenomas (tumors > 1 cm) were excluded. The degree of empty sella syndrome was graded on the degree of CSF visualized in the sella on midline sagittal T1-weighted MRI.RESULTSOf the 197 cases identified, 40 (20%) presented with MRI-negative disease, and empty sella syndrome was present in 49 cases (25%). MRI-negative disease was found in 18 (37%) of 49 empty sella cases versus 22 (15%) of 148 cases without empty sella syndrome present. Empty sella syndrome was significantly associated with MRI-negative disease (OR 3.32, 95% CI 1.61–6.74, p = 0.0018). Decreased thickness of the pituitary gland was also associated with MRI-negative disease (mean thickness 5.6 vs 6.8 mm, p = 0.0002).CONCLUSIONSEmpty sella syndrome is associated with an increased rate of MRI-negative Cushing’s disease. Pituitary compression causing a relative reduction in the volume of the pituitary for imaging is a plausible cause for not detecting the tumor mass with MRI.

scholarly journals Whole-Exome Sequencing Identifies Homozygous GPR161 Mutation in a Family with Pituitary Stalk Interruption Syndrome

2015 ◽  
Vol 100 (1) ◽  
pp. E140-E147 ◽  
Author(s):  
Ender Karaca ◽  
Ramazan Buyukkaya ◽  
Davut Pehlivan ◽  
Wu-Lin Charng ◽  
Kursat O. Yaykasli ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Empty Sella ◽  
Pituitary Stalk ◽  
Pituitary Insufficiency ◽  
Radiographic Findings ◽  
Whole Exome ◽  
Posterior Pituitary Gland ◽  
Pituitary Hypoplasia

Abstract Context: Pituitary stalk interruption syndrome (PSIS) is a rare, congenital anomaly of the pituitary gland characterized by pituitary gland insufficiency, thin or discontinuous pituitary stalk, anterior pituitary hypoplasia, and ectopic positioning of the posterior pituitary gland (neurohypophysis). The clinical presentation of patients with PSIS varies from isolated growth hormone (GH) deficiency to combined pituitary insufficiency and accompanying extrapituitary findings. Mutations in HESX1, LHX4, OTX2, SOX3, and PROKR2 have been associated with PSIS in less than 5% of cases; thus, the underlying genetic etiology for the vast majority of cases remains to be determined. Objective: We applied whole-exome sequencing (WES) to a consanguineous family with two affected siblings who have pituitary gland insufficiency and radiographic findings of hypoplastic (thin) pituitary gland, empty sella, ectopic neurohypophysis, and interrupted pitiutary stalk—characteristic clinical diagnostic findings of PSIS. Design and Participants: WES was applied to two affected and one unaffected siblings. Results: WES of two affected and one unaffected sibling revealed a unique homozygous missense mutation in GPR161, which encodes the orphan G protein–coupled receptor 161, a protein responsible for transducing extracellular signals across the plasma membrane into the cell. Conclusion: Mutations of GPR161 may be implicated as a potential novel cause of PSIS.

Ectopic pituitary adenoma in the sphenoid causing Nelson's syndrome

1997 ◽  
Vol 111 (6) ◽  
pp. 565-567 ◽  
Author(s):  
Francisco Esteban ◽  
Isabel Ruiz-Avila ◽  
Ricardo Vilchez ◽  
Carolina Gamero ◽  
Mercedes Gomez ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Cushing's Syndrome ◽  
Young Female ◽  
Empty Sella ◽  
Rare Occurrence ◽  
Imaging Studies ◽  
Nelson’S Syndrome ◽  
Nelson's Syndrome ◽  
Ectopic Pituitary Adenoma

AbstractAn ectopic functioning pituitary in the sphenoid is an extremely rare occurrence, and even rarer is pituitary adenoma causing symptoms of Nelson's syndrome. A case is presented of a young female diagnosed and treated in our clinic. The only functioning hypophyseal tissue was detected inside the sphenoid, as the pituitary gland had been radiated because of Cushing's syndrome 10 years before and imaging studies revealed an empty sella.

AYURVEDIC MANAGEMENT OF PARTIAL EMPTY SELLA SYNDROME: A CASE REPORT

2021 ◽  
Vol 12 (4) ◽  
pp. 15-18
Author(s):  
Eswara M P Sarma ◽  
Arathi P K
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Pituitary Gland ◽  
Sella Turcica ◽  
Marked Change ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Lukewarm Water

Empty Sella Syndrome is a disorder that involves the presence of Cerebro-spinal fluid in Sella turcica in an excess amount. In empty Sella syndrome the Sella turcica is either partially filled with cerebrospinal fluid and an atrophied pituitary gland lying in the floor of the Sella (Partial Empty Sella Syndrome) or filled with cerebrospinal fluid which pushes the pituitary gland into a side of Sella turcica resulting in non-visualization of the gland. (Completely empty Sella). A 37-year-old female diagnosed with partial empty Sella syndrome was managed with Pathyakshadhatryadi kashayam 15 ml twice daily in empty stomach with 45 ml lukewarm water, Rasnadi choornam tailam application, mahatraiphala ghritam 10 ml at night after food, Kshirabala 7 Avarti tailam pratimarsha nasyam. After completion of the treatment, there was considerable relief in the primary complaint of the patient which was a recurrent headache and the follow up MRI showed a marked change in the condition. This case report highlights the role of Ayurveda in the management of partial empty Sella syndrome and sheds light for further study on the same.

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