Presentation
Loss of sexual desire, gynecomastia, and visual disturbances. Laboratory essay shows hyperprolactinemia.
Patient Data
There is an enlarged sella, which is partially empty, expanded, and filled with CSF with associated downward herniation of the floor of the third ventricle and optic chiasm within. The infundibulum is seen deviated to the left and extends down to the floor of the sella where a thin lining of enhanced pituitary tissue is seen flattened against the sellar floor.
Heterogeneous signal and enhancement of the skull base and the clivus.
Case Discussion
This patient has had a pituitary macroadenoma that was subjected to radiosurgery. Two years later, he started complaining of loss of sexual desire, gynecomastia, and visual disturbances. The Laboratory essay shows hyperprolactinemia and MRI was requested to assess the possibility of tumor residual or recurrence. His MR study revealed empty sella.
Empty sella can be primary (idiopathic) or secondary to a specific cause. It is usually asymptomatic however, it is occasionally associated with hypopituitarism 1 and hyperprolactinemia 2 .
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