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Case based discussion: A rare case of empty sella syndrome in an adult female

Pradeep Kumar Vyas*, Vaishnavi Gurumurthy, Vidyadhara Lakkappan, Lipeeka parulekar, Rakesh singh, Arunav uchil

Empty sella syndrome (ESS) is pathophysiologically characterized by either anatomic abnormalities in the diaphragma sellae (primary ESS), damage to the pituitary by irradiation/surgery, or autoimmunity leading to the availability of “empty” space in the sella (secondary ESS). The most prevalent hormone deficiency is growth hormone (GH), affecting 35% to 61% of adult patients with ESS. The most common symptom is headache which is deep, dull, and central. Sometimes headache is very severe, with giddiness and vomiting. In primary ESS, the sella tends to be symmetrically ballooned without evidence of bony lesions. The suprasellar subarachnoid space herniates through an incomplete sellar diaphragm. Cisternography, high resolution CT scanning, or MRI is used for diagnosis. The signs and symptoms depend upon the size, secretion, and pressure over the pituitary gland. The prevalence of primary empty sella, is not known: range from 2% to 20%. Certain clinical conditions like hormonal disturbances, psychiatric disorders, raised ICT and SNHL have been found to be more often associated with ES as compared to general population. Improvements in neuroradiological imaging techniques have resulted in an increase in the incidental finding of “empty sella.” According to current data from India, an empty sella turcica without any detectable cause is an incidental finding in approximately 2% of all cerebral MRI scans, in asymptomatic patients. It may remain asymptomatic or may simulate an intrasellar growth thereby causing diagnostic and therapeutic problems. An air encephalogram (AEG) is required for diagnosis. The index case diagnosed to have Empty sella syndrome of unclear aetiology and was later on determined on radiographic imaging (MRI) and treated successfully. This syndrome is relatively new and not much reported on a routine basis hence radiographic imaging helps in its diagnosis and management.