several etiopathogeneic hypotheses have been proposed , including a congenital incomplete formation of the sellar diaphragm and suprasellar factors such as a stable or intermittent increase in intracranial pressure as well as volumetric changes in the pituitary ( as observed in pregnancy).[13 ] on the other hand , secondary empty sella ( ses ) may be caused by pituitary adenomas undergoing spontaneous necrosis ( ischemia or hemorrhage ) .
other causes known to cause ses are infective , autoimmune , traumatic , radiotherapy , drugs , and surgery .
numerous studies have shown that empty sella syndrome may be associated with pituitary dysfunction contrary to the notion of it being an incidental finding .
hence this study was undertaken to evaluate the clinical and hormonal profile in patients with empty sella .
patients undergoing a ct / mri at our center , for various reasons but with the finding of empty sella were included in this study .
patients having psychiatric disturbances , critical illness , pregnancy , lactation , or on drugs known to affect pituitary function were excluded from the study .
apart from routine tests , hormonal evaluation included serum thyroid stimulating hormone , t4 , cortisol ( 8 am ) , prolactin ( prl ) , total testosterone , follicle stimulating hormone , leuteinizing hormone and fasting igf 1 , all done by chemiluminescence .
patients with history of pituitary apoplexy , head injury or surgery for pituitary adenoma were considered as ses and patients in whom an etiology was not discernible were considered as pes syndrome .
patients undergoing a ct / mri at our center , for various reasons but with the finding of empty sella were included in this study .
patients having psychiatric disturbances , critical illness , pregnancy , lactation , or on drugs known to affect pituitary function were excluded from the study .
apart from routine tests , hormonal evaluation included serum thyroid stimulating hormone , t4 , cortisol ( 8 am ) , prolactin ( prl ) , total testosterone , follicle stimulating hormone , leuteinizing hormone and fasting igf 1 , all done by chemiluminescence .
patients with history of pituitary apoplexy , head injury or surgery for pituitary adenoma were considered as ses and patients in whom an etiology was not discernible were considered as pes syndrome .
a total of 34 patients , diagnosed radiologically to have empty sella , were evaluated and of them 24 had pes and 10 had ses .
the mean age at diagnosis in subjects with pes was 40.6  9.4 years and that in ses was 37  9.6 years . in both pes and ses female predominance was observed , with the sex ratio being 3:1 and 2.3:1 respectively .
etiology in the cases of ses was sheehans syndrome in five , head trauma in three and post pituitary surgery in two . in the female patients with pes 83.3% ( 15/18 ) were multiparous and only 11% ( 2/18 ) were nulliparous , mean numbers of pregnancies in the multiparous women being 3.26  0.79 .
the mean bmi in patients with pes was 26.4  4.2 kg / m and that in ses was 24.3  2.1 kg / m [ table 1 ] .
table showing patients with pes in different bmi groups most common presenting feature in pes was headache , present in 12 patients ( 50% ) .
the headache was variable in localization , severity and duration , the most common pattern being diffuse with moderate intensity and a duration dating to few years .
three patients associated vomiting and evidence of papilledema suggestive of benign intracranial hypertension . however , cerebrospinal fluid ( csf ) pressures were not measured in these cases .
all the patients of ses had panhypopituitarism , the most common presenting symptom being secondary amenorrhea in females and features of hypocortisolism in males . in subjects with pes , 12 out of 24 ( 50 % ) had endocrine dysfunction , though such dysfunction was clinically suspected in only eight of them .
the most common endocrine dysfunction noted was hyperprolactinemia , which was seen in 5 ( 20.8% ) patients .
four of these patients were females and none of the patients had serum prl levels more than 100 g / l ( mean 61.96  13.5
three of these five patients had isolated hyperprolactinemia while the other two had associated anterior pituitary hormonal deficiencies . in the pes subjects , 37.5% had at least one hormonal deficiency , the most common being isolated igf 1 deficiency seen in four patients ( 12.5% ) .
other hormonal deficiencies that were seen in this group were isolated hypogonadotropic hypogonadism in two patients ( 8.3% ) , isolated central hypothyroidism in one patient ( 4.1% ) , isolated hypocortisolism in one patient ( 4.1% ) , and multiple pituitary hormone deficiency ( hypocortisolism and hypogonadism ) in one patient ( 4.1% ) .
all the patients of ses had panhypopituitarism , the most common presenting symptom being secondary amenorrhea in females and features of hypocortisolism in males . in subjects with pes , 12 out of 24 ( 50 % ) had endocrine dysfunction , though such dysfunction was clinically suspected in only eight of them .
the most common endocrine dysfunction noted was hyperprolactinemia , which was seen in 5 ( 20.8% ) patients .
four of these patients were females and none of the patients had serum prl levels more than 100 g / l ( mean 61.96  13.5
three of these five patients had isolated hyperprolactinemia while the other two had associated anterior pituitary hormonal deficiencies . in the pes subjects , 37.5% had at least one hormonal deficiency , the most common being isolated igf 1 deficiency
other hormonal deficiencies that were seen in this group were isolated hypogonadotropic hypogonadism in two patients ( 8.3% ) , isolated central hypothyroidism in one patient ( 4.1% ) , isolated hypocortisolism in one patient ( 4.1% ) , and multiple pituitary hormone deficiency ( hypocortisolism and hypogonadism ) in one patient ( 4.1% ) .
the reported prevalence of pes in general population is 8 - 35% . in our study pes
accounted for most cases of empty sella and it was more commonly noted in females with higher parity , as has been seen in earlier studies .
enlargement of the pituitary during pregnancy may lead to weaken of the sellar diaphragm , thus predisposing to herniation of cerebrospinal fluid into the sella .
obesity causes obstructive sleep apnea leading to hypercapnia and increased csf pressure predisposing to empty sella .
this is thought to be due to pituitary stalk compression as a consequence of the remodeling of the hypothalamo - pituitary region and altered csf dynamics .
the most common hormonal deficiency was isolated growth hormone deficiency followed by isolated gonadotropin deficiency , which is compatible with previous studies .
somatotrophs are probably a more vulnerable component of the pituitary in pes , hence systematic gh testing and gh substitution considered in pes .
the high incidence of endocrine abnormalities in patients with pes , even when asymptomatic , mandates that these patients should routinely be subjected to endocrine evaluation to detect these deficiencies early , and appropriate replacement instituted where necessary , thus ensuring them of a better quality of life .
 introduction : empty sella is characterized by the herniation of the subarachnoid space within the sella , which is often associated with some degree of flattening of the pituitary gland . 
 this study was undertaken to evaluate the clinical and hormonal profile in patients with empty sella.aims and objectives : to evaluate the clinical and hormonal profile of the patients with an empty sella.materials and methods : patients undergoing a ct / mri at our center , for various reasons but with the finding of the empty sella were included in this study . 
 a detailed history and clinical examination was done . 
 apart from routine tests , hormonal evaluation included serum thyroid stimulating hormone , t4 , cortisol ( 8 am ) , prolactin , total testosterone , follicle stimulating hormone , leutinizing hormone , and fasting insulin like growth factor 1 ( igf 1 ) were done.results:a total of 34 patients , diagnosed radiologically to have empty sella , were evaluated and of them 24 had primary empty sella ( pes ) and 10 had secondary empty sella ( ses ) . in subjects with pes , 12 out of 24 ( 50% ) had endocrine dysfunction . 
 the most common endocrine dysfunction noted was hyperprolactinemia , which was seen in 5 ( 20.8% ) patients and the most common hormonal deficiency was isolated gh deficiency seen in four patients ( 12.5%).conclusion : 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 , and appropriate replacement instituted where necessary , thus ensuring them of a better quality of life . 
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