Investigation of etiology in patients with primary empty sellapresenting to the outpatient clinic

Şeber Boyacı, D. Investigation of Etiology in Patients with Primary Empty Sella Presenting to the Outpatient Clinic, Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Specialty Thesis, Eskişehir, 2025. This study aimed to investigate possible etiological factors in patients diagnosed with primary empty sella at the endocrinology outpatient clinic and evaluate their relationships with clinical, demographic, and hormonal characteristics. This retrospective study included patients diagnosed with empty sella on brain and/or pituitary MRI, excluding secondary causes. 93 patients were evaluated with a pituitary hormone panel. Demographic data, clinical features, labs, and imaging were reviewed from patient files and hospital records. Among patients, 75.3% were female, 24.7% male, with a mean age of 54.99 years. BMI was over 25 kg/m² in 79.6%. Female patients had an average of 3 pregnancies, with 73% multiparous. Common symptoms included fatigue, headache, and sexual dysfunction. The most frequent chronic diseases were essential hypertension (47%), diabetes mellitus (36%), and pituitary insufficiency (33%). Less common conditions included acromegaly, Cushing's disease, Arnold- Chiari malformation, and KISS1R mutation-related hypogonadotropic hypogonadism. Growth hormone deficiency was the most common isolated hormone deficiency (26.9%). Imaging showed partial empty sella in 64.5% and total empty sella in 35.5%. Empty sella was more frequent in multiparous women, obese individuals, and middle- aged to older adults. Essential hypertension, obstructive sleep apnea syndrome (OSAS), obesity, autoimmune thyroid diseases, and benign intracranial hypertension (BIH) seem involved in its etiology. Although patients may be asymptomatic, clinical follow-up and pituitary hormone panels are recommended every 24–36 months to detect pituitary insufficiency. Key Words: empty sella, hypopituitarism, panhypopituitarism, multiparity, benign intracranial hypertension