TOPLINE:

Primary and secondary empty sella demonstrated distinct clinical trajectories and endocrine burdens despite similar radiologic appearances. Although primary empty sella maintained stable pituitary function in more than 80% of patients over nearly 5 years, secondary empty sella carried a substantially higher risk for progressive hormonal deficiencies affecting multiple axes.

METHODOLOGY:

• Researchers in Italy conducted a retrospective longitudinal study to characterise baseline and longitudinal endocrine outcomes in patients with primary and secondary empty sella in real-world practice.
• They included 258 adult patients (median age at diagnosis, 51.5 years; 64.3% women) with radiologic evidence of empty sella on CT and/or MRI. The median follow-up duration was 58.5 months.
• Patients were categorised as having primary empty sella (n = 159) if no previous pituitary or sellar disease was present and having secondary empty sella (n = 99) if pituitary injury was present due to surgery, radiotherapy, apoplexy, Sheehan syndrome, hypophysitis, trauma, infection, granulomatous disease, or other hypothalamic-pituitary disorders.
• All patients were evaluated for clinical and neuroradiologic characteristics, comorbidities, and comprehensive pituitary hormonal profile at baseline and during follow-up.

TAKEAWAY:

• The prevalence of primary empty sella was higher than that of secondary empty sella (61.6% vs 38.4%).
• Overall, 41.1% of patients experienced at least one pituitary hormone deficiency, which was more frequent in those with secondary empty sella than in those with primary empty sella (62.6% vs 27.7%).
• Gonadotropic hormone deficiency was most frequent in this cohort, with follicle-stimulating or luteinising hormone deficiency being reported in 32% of patients, followed by growth hormone deficiency (22.5%), adrenocorticotropic hormone deficiency (20.0%), and thyroid-stimulating hormone deficiency (20.2%).
• Pituitary function remained stable in 83.3% of patients with primary empty sella. Conversely, those with secondary empty sella had a significantly higher risk of developing new corticotropic deficiency (7.4%), thyrotropic deficiency (11.6%), and gonadotropic deficiency (5.3%; P < .05 for all).

IN PRACTICE:

"This study provides additional long-term data that may help guide a more personalized approach to the management of patients with ES [empty sella], to optimize patient management, prevent delayed diagnosis of evolving hypopituitarism in SES [secondary ES], and avoid unnecessary follow-up in PES [primary ES]," the authors wrote.

SOURCE:

This study was led by Nicolò Bacchi, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy. It was published online on June 08, 2026, in the Journal of Endocrinological Investigation.

LIMITATIONS:

The study was limited by the retrospective design and possibility of referral bias. Patients with primary and secondary empty sella were diagnosed in different clinical contexts, which may have introduced selection bias.

DISCLOSURES:

Open access funding was provided by Università degli Studi di Modena e Reggio Emilia. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.