The Epidemiology and Hormonal Assessment of Patients with Empty Sella on Pituitary Magnetic Resonance: A Retrospective Single Centre Study in Saudi Community Based Hospital

Abstract

Khalid S.Aljabri, Samia A.Bokhari, Faisal A.Assiri, Muneera A. Alshareef, Patan M. Khan and Bandari K. Aljabri

Background: No large enough series have been reported to allow a detailed definition of the epidemiology of primary empty sella (PES) and diagnostic anterior pituitary hormones abnormalities in Saudi Arabia.

Objective: To evaluate the epidemiological and hormonal profile of patients with PES. Design: Retrospective analysis of pituitary Magnetic Resonance Image (MRI) and hormonal data of patients with PES between January 2008 and December 2017. Settings: Departments of Endocrinology and Radiology at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Patients: 537 patients with clinical, hormonal and radiological data. Main outcome measures: The frequency of PES in patients and associated abnormal pituitary hormones.

Results: Over the 9-year period, Out of 537 patients; 161 (30 %) were male and 376 (70 %) were female with mean age 35.4 ± 13.7. Among them we found 50 (9.3%) cases with PES on MRI. 11 (22 %) cases were male and 39 (78 %) were female with female to male ratio of 3.5 to 1. Cases with PES were significantly older than cases with pituitary adenoma and normal MRI, 45.3 ± 19.6 vs. 35.3 ± 13.9, p value <0.0001. PES occurred with the greatest frequency at the fourth decade. During the hormonal assessment, 34 (68%) cases of PES were found to have some degree of anterior pituitary hormones abnormailities. No anterior pituitary hormones abnormalities were found in 16 (32%) of cases. Hyperprolactinemia was found in 26 (52%) of cases. Cases of hypogonadotropic hypogonadism and central hypothyroidism were equally distributed, 4 cases ( 8% ). Female predominance was found.

Conclusion: In our study, PES was more common in middle aged female. The high incidence of endocrine abnormalities in patients with PES mandates that these patients should routinely be subjected to endocrine evaluation to detect these deficiencies early. Limitations: Question of clustering of cases within the study region and limited study sample size.