Primary Empty Sella and Acromegaly: Case Series and Systematic Review

Purpose: Investigating Primary empty sella (ES) in patients with acromegaly for possible etiology, complications, and treatment options. Method: We searched for primary ES, among 220 acromegaly patients referred to our center from 2013 to 2020. Data were collected from hospital records and were completed through phone calls with patients. Finally, we conducted a systematic literature review of previous reports for patients with primary ES and acromegaly who underwent transsphenoidal surgery. Result: We found 31 patients with primary ES. The mean age was 46 years with a male to female ratio of 12:11. Surgical data was available for 23 patients. Total ES was found in 18 patients. Six patients had adenoma invasion into the clivus or sphenoid sinus. The tumor extended into the cavernous sinus in 10 patients. CSF leak was observed in three patients during surgery. Hormonal laboratory data were available for 17 patients. GH/IGF1 was controlled without any replacement therapy in nine patients. The most common simultaneous hormonal disturbance was high prolactin levels. No pituitary hormonal abnormalities occurred after transsphenoidal surgery except for hypothyroidism in one patient. Conclusion: Primary ES is not an unusual finding in acromegaly patients. Transsphenoidal surgery as a first-line treatment carries a reasonable complication rate.