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Mensagem  Diego Luiz em Sex Mar 08, 2013 8:09 am

Empty sella — An empty sella refers to an enlarged sella turcica that is not entirely filled with pituitary tissue. It is a radiologic description and not a clinical condition. There are two types:
• Secondary empty sella is characterized by association of the empty sella with an identifiable disease of the pituitary gland. One example of an identifiable disease is a mass, such as a pituitary adenoma, that enlarges the sella, but then is removed by surgery, radiation, or infarction. In this type of empty sella, hypopituitarism can result from the adenoma itself, its treatment, or infarction. A remnant of a partially removed pituitary adenoma could have residual function. Another example is a congenital abnormality of a transcription factor necessary for pituitary differentiation, where the sella turcica is normal but the pituitary gland is small.
• Primary empty sella is characterized by a defect in the diaphragm sella that is thought to allow CSF pressure to enlarge the sella . Although some papers claim deficiencies of one or more pituitary hormones , the evidence for such deficiencies is not convincing, ie, there is no consistent evidence of the existence of an "empty sella syndrome."
• Evaluation of a patient whose MRI shows an empty sella, therefore, depends on what else is seen in the sella and the clinical situation. The presence of a sellar mass, especially a lesion more than 1 cm in size, requires evaluation for hormonal hypersecretion and hyposecretion, as does any other sellar mass. Clinical evidence of hormonal excess or deficiencies requires biochemical evaluation of all pituitary hormones. In the absence of a sellar mass and clinical evidence of hormonal excess or deficiency, measurement of thyroxine and early morning cortisol could be performed, but the likelihood is that they will be normal.


Diego Luiz

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