A Multicenter Cohort Study in Patients With Primary Empty Sella: Hormonal and Neuroradiological Features Over a Long Follow-Up

Giulia Carosi, Alessandro Brunetti, Alessandra Mangone, Roberto Baldelli, Alberto Tresoldi, Giulia Del Sindaco, Elisabetta Lavezzi, Elisa Sala, Roberta Mungari, Letizia Maria Fatti, Elena Galazzi, Emanuele Ferrante, Rita Indirli, Emilia Biamonte, Maura Arosio, Renato Cozzi, Andrea Lania, Gherardo Mazziotti, Giovanna Mantovani

Research output: Contribution to journalArticlepeer-review


Objective: primary empty sella (PES) represents a frequent finding, but data on hormonal alterations are heterogeneous, and its natural history is still unclear. Our aim was to evaluate the pituitary function of patients with PES over a long follow-up. Design: multicenter retrospective cohort study enrolling patients referred between 1984-2020 to five Pituitary Units, with neuroradiological confirmed PES and a complete hormonal assessment. 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). Results: we recruited 402 patients (females=63%, mean age=51.5 ± 16 years) with PES (partial, total, undefined in 66%, 13% and 21%, respectively). 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%. Interestingly, hormonal alterations were diagnosed in 29% of incidental PES. 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. A longitudinal assessment was possible in 166/402 (median follow-up=58 months). In 5/166 (3%), new deficiencies occurred, whereas 14/166 (8.4%) showed a hormonal recovery. 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). Conclusions: this is the largest cohort of patients with PES reported. Hypopituitarism is frequent (40%) but hormonal deterioration seems uncommon (3%). Patients need to be carefully evaluated at diagnosis, even if PES is incidentally discovered.

Original languageEnglish
Article number925378
JournalFrontiers in Endocrinology
Publication statusPublished - Jun 23 2022


  • empty sella
  • hypogonadism
  • hypopituitarism
  • intracranial hypertension
  • neuroendocrinology
  • pituitary
  • sella turcica
  • traumatic brain injury

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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