EMPTY SELLA IN CHILDREN AND ADOLESCENTS WITH POSSIBLE HYPOTHALAMIC-PITUITARY DISORDERS

Several computed tomographic scan studies have described empty sellae in children with hypothalamic-pituitary disorders. Magnetic resonance imaging, however, is a more precise technique for visualizing the intr asellar content, such as the stalk and pituitary lobes. Using magnetic resonance imaging, we studied 339 children and adolescents (mean age +/- SD, 12.7 +/- 4.5 yr) with possible hypothalamic-pituitary disorder s to ascertain the frequency of primary empty sella and examine its re lationships;with other intrasellar abnormalities, pituitary function, and adverse perinatal events. One hundred and ninety-three patients ha d isolated GH deficiency, 43 had multiple pituitary hormone deficiency , 10 had diabetes insipidus, 17 had hypogonadotropic hypogonadism, 5 h ad idiopathic delayed puberty, 47 had precocious puberty, and 24 had o ther hypothalamic pituitary disorders of hyperfunction. One tenth (10. 9%) of the patients (37 cases) had empty sella, with a marked variatio n of incidences among the disorders listed above. A statistically high er frequency of subjects with empty sellae was found only in patients with multiple pituitary hormone deficiency. Patients with and without empty sellae were not different in regard to age or sex. The incidence of empty sella in the various groups of patients was as follows: isol ated GH deficiency, 8.8% (17 cases); multiple pituitary hormone defici ency, 34.9% (15 cases); hypogonadotropic hypogonadism, 5.9% (1 case); idiopathic delayed puberty, 40% (2 cases); and precocious puberty, 4.2 % (2 cases). No patients with isolated diabetes insipidus or other hyp othalamic-pituitary disorders had empty sellae. In the patients with e mpty sellae, abnormalities of the stalk or posterior lobe were found i n 1 patient with isolated GH deficiency (5.9%), 13 patients with multi ple pituitary hormone deficiency (86.7%), and no patients with puberty disorders. Likewise, adverse perinatal events were found only in 1 pa tient with isolated GH deficiency and 9 patients with multiple pituita ry hormone deficiency. These findings suggest that empty sella is not rare in children and adolescents evaluated for hypothalamic-pituitary disorders, particularly if there is multiple pituitary hormone deficie ncy. Empty sella can be found regardless of abnormalities of the stalk and posterior lobe, and adverse perinatal events do not seem to be th e primary etiological factor. Empty sella is usually associated with p ituitary hypofunction, but it can be found in patients with hyperfunct ion of the hypothalamic-pituitary-gonadal axis.