Analysis Of Clinical Features Of Primary Empty Sella

Objective:Retrospective analysis of clinical data of 60 patients with primary empty sella(PES)was conducted to explore the pathogenesis,clinical features,changes in pituitary function of PES,in order to further improve the understanding of the disease,and provide a basis for clinical evaluation of the etiology,diagnosis and treatment of this disease.Methods:The clinical data of 60 patients diagnosed with PES who were admitted to the Endocrinology department of our hospital from 2000 to 2018 for different reasons.The gender,age,body mass index,female pregnancy history,clinical features,and endocrine hormone levels were retrospectively reviewed and analysed.Results: 1.Baseline data: There were 60 cases,including 22 male patients(36.67%)and 38 female patients(63.33%).The male to female ratio was 1:1.73.The age is 51.52±13.68 years old(range 15 years old-76 years old).It were more common in 50-59 years old group and women with multiple pregnancies.2.The main clinical manifestations: 0f 60 patients,41.67% patients had fatigue and 26.67% had dizziness and headache,21.67% patients had nausea and vomiting,18.33% had anorexia,6.67% patients had visual impairment,and other symptoms.3.Assessment of pituitary function: In 60 patients with PES,evaluation of pituitary function showed that 27 patients had normal pituitary function(45.0%)and 33 patients(55.0%)had pituitary dysfunction.Pituitary hypothyroidism was 26.7%(16/60),pituitary adrenal insufficiency 40.0%(24/60),pituitary hypoganadism 16.7%(10/60).Among them,16 patients developed single one-axis dysfunction(48.5%)with 4 cases(12.1%)of only thyroid axis impairment,8(24.2%)of only adrenal axis involvement,4(12.1%)of single pituitary hypoganadism.13(39.4%)had two-axis hypofunction with 6 cases(18.2%)of both hypothyroidism and adrenal insufficiency,4 cases(12.1%)with hypothyroidism plus hypoganadism,and 3 cases(9.1%)with adrenal insufficiency in addition to hypoganadism.The three axes were affected in 4 cases(12.1%).Complete empty sella was more prone to result in pituitary dysfunction than partial empty sella.Men with PES were more likely to have hypopituitarism than women.Conclusion: 1.The incidence of PES in men and women of different genders is significantly higher in women than in men,and is common in middle-aged and elderly women with multiple pregnancies.2.The main symptoms of the disease may be fatigue,dizziness,headache,visual impairment,cerebrospinal fluid rhinorrhea and endocrine dysfunction and other discomfort,and may lack certain specificity in clinical manifestations compared with other diseases.Therefore,if the above symptoms occur,the condition of the sella should be screened to reduce the misdiagnosis and missed diagnosis rate of the disease.Especially for patients with diabetes complicated with empty sella,the choice and dosage of hypoglycemic drugs should be carefully grasped to guard against the appearance of hypoglycemia.3.About half of PES patients may develop pituitary dysfunction.Therefore,for patients with empty sella detected by MRI with or without clinical symptoms,once diagnosed,the pituitary function should be fully evaluated in time.If pituitary dysfunction occurs,the target hormone replacement therapy should be given in a timely manner,and long-term follow-up should be conducted to regularly evaluate the pituitary function so as not to delay the disease.