{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:40:31Z","timestamp":1791891631207,"version":"4.3.4"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Primary Empty Sella (PES) syndrome is an increasingly common disorder, mostly diagnosed as an incidental finding during brain imaging scans. We intended to review the clinical management and hormonal profile of patients with PES.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The study included ten-year retrospective analysis of registry containing PES cases in the period 2007 to 2017, from a single tertiary care center. The keyword \u2018primary empty sella\u2019 was used to retrieve patient details from the radiology unit. The clinical and biochemical profile of PES patients was analyzed. Case management of PES patients and their rate of referral to endocrinologists was explored.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The registry had 765 cases with a male: female ratio of 1:3.8 suggesting female predominance by almost four times. Although not significant, the onset of disease was earlier for males [Mean\u2009\u00b1\u2009standard deviation (SD) (46.7\u2009years \u00b117.3 vs 48.8\u2009years\u00b114.1), <jats:italic>p<\/jats:italic>\u2009=\u20090.110]. Almost 79% of the cases were found as an incidental finding during Magnetic Resonance Imaging. Of the total PES cases, only 20% were referred to the endocrinologists and the rest were handled by general physicians. Only 1\u20132.5% of the cases were evaluated for gonadal, growth and adrenal hormones by the general physicians. The hormonal evaluation by the endocrinologists was also found to be sub-optimal. Headache and visual disturbances were the most common presenting complaints followed by menstrual abnormalities. Endocrine abnormalities like thyroid dysfunction, hyperprolactinemia, hypogonadism and hypocortisolism were highly prevalent among those assessed.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>There is a gross under-evaluation of hormonal assessment and minimal case-referral to Endocrinologists. PES is associated with varying degrees of hormonal dysfunction, and hence early assessment and management is needed. Establishing a standard protocol for diagnosis and case management is essential with the involvement of a multidisciplinary team consisting of endocrinologists, neurologists, primary care phys icians and ophthalmologists.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12902-020-00621-5","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T14:15:20Z","timestamp":1600352120000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Clinical presentation, evaluation and case management of primary empty sella syndrome: a retrospective analysis of 10-year single-center patient data"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-0631","authenticated-orcid":false,"given":"Aishah A.","family":"Ekhzaimy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Mujammami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabana","family":"Tharkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manahel A.","family":"Alansary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daad","family":"Al Otaibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"key":"621_CR1","unstructured":"Stelmachowska-Bana\u015b M, Czajka-Oraniec I, Zgliczy\u0144ski W. Clinical and hormonal assessment of patients with empty Sella on MRI. Post\u0119py Nauk Medycznych. 2014;12:814\u20138."},{"key":"621_CR2","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1148\/90.5.931","volume":"90","author":"B Kaufman","year":"1968","unstructured":"Kaufman B. The \u201cEmpty\u201d Sella Turcica - A Manifestation of the Interstellar Subarachnoid Space. Radiology. 1968;90:931.","journal-title":"Radiology"},{"key":"621_CR3","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.mjafi.2015.11.012","volume":"72","author":"J Debnath","year":"2016","unstructured":"Debnath J, Ravikumar R, Sharma V, Senger KP, Maurya V, Singh G, Sharma P, Khera A, Singh A. Empty sella\u2019 on routine MRI studies: An incidental finding or otherwise? Med J Armed Forces India. 2016;72:33\u20137.","journal-title":"Med J Armed Forces India"},{"key":"621_CR4","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/0002-9343(77)90420-X","volume":"62","author":"RM Jordan","year":"1977","unstructured":"Jordan RM, Kendall JW, Kerber CW. Primary empty Sella syndrome analysis of the clinical characteristics, radiographic features, pituitary function and cerebrospinal fluid Adenohypophysial hormone concentrations. Am J of Med. 1977;62:569\u201381.","journal-title":"Am J of Med"},{"issue":"6","key":"621_CR5","first-page":"803","volume":"81","author":"M Foresti","year":"1991","unstructured":"Foresti M, Guidali A, Susanna P. Primary empty Sella. Incidence in 500 asymptomatic subjects examined with magnetic resonance. Radiol Med. 1991;81(6):803\u20137.","journal-title":"Radiol Med"},{"key":"621_CR6","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1530\/EJE-17-0505","volume":"177","author":"S Chiloiro","year":"2017","unstructured":"Chiloiro S, Giampietro A, Bianchi A, Tartaglione T, Capobianco A, Anile C, De Marinis L. Primary empty Sella: a comprehensive review. Eur J Endocrinol. 2017;177:275\u201385.","journal-title":"Eur J Endocrinol"},{"key":"621_CR7","volume-title":"Hypopituitarism","author":"TT Chung","year":"2000","unstructured":"Chung TT, Koch CA, Monson JP. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Hypopituitarism. South Dartmouth: Endotext; 2000. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK278989\/. MDText.com, Inc.; Updated 2018 Jul 25."},{"key":"621_CR8","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1007\/BF03345517","volume":"25","author":"B Ambrosi","year":"2002","unstructured":"Ambrosi B, Faglia G. How much of our pituitary is really necessary? J Endocrin Invest. 2002;25:812.","journal-title":"J Endocrin Invest"},{"key":"621_CR9","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1007\/s11102-012-0416-6","volume":"16","author":"M Guitelman","year":"2013","unstructured":"Guitelman M, Garcia Basavilbaso N, Vitale M, Chervin A, Katz D, et al. Primary empty Sella (PES): a review of 175 cases. Pituitary. 2013;16:270\u20134.","journal-title":"Pituitary."},{"key":"621_CR10","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/j.1365-2265.1992.tb01484.x","volume":"37","author":"E Gallardo","year":"1992","unstructured":"Gallardo E, Schachter D, Caceres E, Becker P, Colin E, Martinez C, Henriquez C. The empty Sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances. Clin Endocrinol. 1992;37:529\u201333.","journal-title":"Clin Endocrinol"},{"key":"621_CR11","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.jns.2004.05.009","volume":"223","author":"JA Galvin","year":"2004","unstructured":"Galvin JA, Van Stavern GP. Clinical characterization of idiopathic intracranial hypertension at the Detroit medical center. J Neurol Sci. 2004;223:157\u201360.","journal-title":"J Neurol Sci"},{"issue":"5","key":"621_CR12","first-page":"1125","volume":"200","author":"AM Saindane","year":"2013","unstructured":"Saindane AM, Lim PP, Aiken A, Chen Z, Hudgin PA. Factors determining the clinical significance of an \u201cempty\u201d Sella Turcica. Neuroradiology. 2013;200(5):1125\u201331.","journal-title":"Neuroradiology."},{"key":"621_CR13","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/s00234-006-0095-y","volume":"48","author":"R Agid","year":"2006","unstructured":"Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson G. Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology. 2006;48:521\u20137.","journal-title":"Neuroradiology"},{"key":"621_CR14","doi-asserted-by":"publisher","first-page":"831","DOI":"10.3171\/jns.2005.103.5.0831","volume":"103","author":"G Maira","year":"2005","unstructured":"Maira G, Anile C, Mangiola A. Primary empty Sella syndrome in a series of 142 patients. J Neurosurg. 2005;103:831\u20136.","journal-title":"J Neurosurg"},{"issue":"3","key":"621_CR15","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1210\/jcem-34-3-570","volume":"34","author":"R Brisman","year":"1972","unstructured":"Brisman R, Hughes JE, Holub DA. Endocrine function in nineteen patients with empty Sella syndrome. J Clin Endocrinol Metab. 1972;34(3):570\u20133.","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"621_CR16","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1507\/endocrj.K06-024","volume":"53","author":"P Del Monte","year":"2006","unstructured":"Del Monte P, Foppiani L, Cafferata C, Marugo A, Bernasconi D. Primary \u201cempty sella\u201d in adults: endocrine findings. Endocr J. 2006;53(6):803\u20139.","journal-title":"Endocr J"},{"issue":"4","key":"621_CR17","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/BF03344013","volume":"25","author":"M Gasperi","year":"2002","unstructured":"Gasperi M, Aimaretti G, Cecconi E, et al. Impairment of GH secretion in adults with primary empty Sella. J Endocrinol Investig. 2002;25(4):329\u201333.","journal-title":"J Endocrinol Investig"},{"key":"621_CR18","doi-asserted-by":"publisher","first-page":"S321","DOI":"10.4103\/2230-8210.93782","volume":"16","author":"V Ghatnatti","year":"2012","unstructured":"Ghatnatti V, Sarma D, Saikia U. Empty sella syndrome \u2013 beyond being an incidental finding. Indian J Endocrinol Metab. 2012;16:S321\u20133.","journal-title":"Indian J Endocrinol Metab"},{"issue":"1","key":"621_CR19","first-page":"91","volume":"48","author":"M Poggi","year":"2012","unstructured":"Poggi M, Monti S, Lauri C, Pascucci C, Bisogni V, Toscano V. Primary empty Sella and GH deficiency: prevalence and clinical implications. Ann Ist Super Sanita. 2012;48(1):91\u20136.","journal-title":"Ann Ist Super Sanita"},{"key":"621_CR20","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1001\/archinte.1983.00350070103017","volume":"143","author":"H Gharib","year":"1983","unstructured":"Gharib H, Frey HM, Laws ER Jr, Randall RV, Scheithauer BW. Coexistent primary empty sella syndrome and hyperprolactinemia. Arch Intern Med. 1983;143:1383\u20136.","journal-title":"Arch Intern Med"},{"issue":"2","key":"621_CR21","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/s10238-009-0071-z","volume":"10","author":"R Garc\u00eda-Centeno","year":"2010","unstructured":"Garc\u00eda-Centeno R, Su\u00e1rez-Llanos JP, Fern\u00e1ndez-Fern\u00e1ndez E, And\u00eda-Melero V, S\u00e1nchez P, Jara-Albarr\u00e1n A. Empty sella and primary autoimmune hypothyroidism. Clin Exp Med. 2010;10(2):129\u201334.","journal-title":"Clin Exp Med"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-020-00621-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-020-00621-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-020-00621-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T23:19:04Z","timestamp":1631834344000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-020-00621-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,17]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["621"],"URL":"https:\/\/doi.org\/10.1186\/s12902-020-00621-5","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,17]]},"assertion":[{"value":"1 September 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The approval of the study was obtained by the Institution Review Board (IRB), College of Medicine, King Saud University. Since the present study is a retrospective analysis of patient data, consent to participate was not applicable. However, anonymity was still maintained since data extraction was based on the hospital registration number.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"142"}}