Empty sella in children with pituitary dwarfism: does it exist?

Empty sella is a descriptive term used to define an anatomoradiological entity characterized by penetration of cerebrospinal fluid (CSF) and subarachnoid space within the sella cavity. To clarify the relationship between empty sella and the endocrinological abnormalities frequently associated in pediatric patients, we examined the hormonal and radiological characteristics of 16 short children with empty sella. In all patients the diagnosis of empty sella was made by computerized tomography (CT) examination. In 5 of 16 patients a magnetic resonance imaging (MRI) study of the sellar region was performed. Growth hormone deficiency (GHD) was found in all 16 patients, hypothyroidism in 6 of 16, hyperprolactinemia in 1 of 16, gonadotropin deficiency in 4 of 11, low cortisol levels in 4 of 13 patients. None of our patients had a CT image of classical empty sella. MRI showed instead the presence of hypoplastic pituitary and disrupted stalk in all patients. In conclusion the endocrinological investigation revealed the presence of isolated GHD in 7 of 16 and multiple hormone defects in 9 of 16 of our patients. This situation is probably not related to a classical empty sella, but depends on a pituitary hypoplasia as the MRI study properly demonstrated.