Sinus Bradycardia as a Rare and Unusual Presentation of Partial Empty Sella Syndrome: A Case Report

Asymptomatic Empty Sella: A Literature Review and Suggestions for Evaluation in Clinical Practice

Empty sella (ES) is a radiographic finding defined by the presence of cerebrospinal fluid in the sella turcica, with associated compression of the pituitary gland. Empty sella syndrome (ESS) is the combination of this radiographic finding with endocrine, ophthalmological, and/or neurological symptoms. The focus of this literature review is to synthesize information about asymptomatic or incidental ES specifically, meaning the radiologic finding of an empty sella without symptoms. This condition is typically discovered incidentally through imaging when patients present with unrelated pathologies. Our intention is to strengthen the existing body of work on this clinical presentation and call for a standardized management protocol of ES. This literature review was performed in concordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Data were extracted on paper characteristics, epidemiology, diagnostics, management, and outcomes. Overall, patients with radiographic findings of ES have a good prognosis. The majority of patients never become symptomatic (progression to ESS), and if symptoms do arise, they usually have little impact on quality of life. However, despite its inherent asymptomatic nature, given ES's estimated prevalence within society, the possibility of a critical underlying pathology, and the potential for subsequent development of consequential symptoms, this paper calls for the implementation of a standardized management protocol. We suggest that all patients with this finding and an unidentified underlying etiology, at a minimum, receive an endocrine panel for evaluation of pituitary function and a referral to ophthalmology for formal assessment of papilledema. We then recommend tailored management and referrals based on the results of these evaluations, as well as treatment of any subsequent symptomatology. While these are our recommendations based on a thorough review of the literature, further studies are necessary to reach a consensus on best clinical practices.

Retrospection of Seldom-Known Causes and Presentations of Partial Empty Sella Syndrome

Pituitary gland shrinkage or flattening obscures it from view on an MRI, giving the impression that it is an empty sella. On the other hand, if some viable pituitary gland tissue is still seen on the MRI scan, a diagnosis of partial empty sella can be made. Diminished physiological and functional reserve in the elderly can result in a bad prognosis if not treated early. Therefore, there is a need to become familiar with fewer known causes and presentations of the empty sella or partial empty sella syndrome in older patients. We report a case of a 71-year-old female with multiple known ailments presenting with hypotension as the sole symptom. It urged us to investigate further and reach the root cause as partial empty sella syndrome with panhypopituitarism.

Empty Sella Prevalence: Step By Step

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.

Magnetic resonance imaging of the hypothalamo-pituitary region

The diagnosis and management of mass lesions in the sellar and parasellar areas remain challenging. When approaching patients with possible sellar or hypothalamic masses, it is important not only to focus on imaging but also detect possible pituitary hormone deficits or excess, in order to establish an appropriate diagnosis and initiate treatment. The imaging modalities used to characterize hypothalamic and pituitary lesions have significantly evolved over the course of the past several years. Computed tomography (CT) and CT angiography play a major role in detecting various sellar lesions, especially in patients who have contraindications to magnetic resonance imaging (MRI) and can also yield important information for surgical planning. However, MRI has become the gold standard for the detection and characterization of hypothalamic and pituitary tumors, infections, cystic, or vascular lesions. Indeed, the imaging characteristics of hypothalamic and sellar lesions can help narrow down the differential diagnosis preoperatively. In addition, MRI can help establish the relationship of mass lesions to surrounding structures. A pituitary MRI examination should be obtained if there is concern for mass effect (including visual loss, ophthalmoplegia, headache) or if there is clinical suspicion and laboratory evidence of either hypopituitarism or pituitary hormone excess. The information obtained from MRI images also provides us with assistance in planning surgery. Using intraoperative MRI can be very helpful in assessing the adequacy of tumor resection. In addition, MRI images yield reliable data that allow for noninvasive monitoring of patients postoperatively.