Advertisement

Clinical and Experimental Medicine

, Volume 10, Issue 2, pp 129–134 | Cite as

Empty sella and primary autoimmune hypothyroidism

  • Rogelio García-Centeno
  • José Pablo Suárez-Llanos
  • Elisa Fernández-Fernández
  • Victor Andía-Melero
  • Petra Sánchez
  • Antonino Jara-Albarrán
Original Article

Abstract

In order to assess the association between empty sella (ES) and primary autoimmune hypothyroidism, and the possibility of a common pathogenesis. We retrospectively studied all patients with presumed ES diagnosed in the last 20 years, most of whom were treated by our Endocrinology Department. Subjects with a known etiology were excluded. Incomplete records or those with a doubtful diagnosis were also excluded. A total of 56 subjects were included in the study. ES was diagnosed by pituitary MRI. The measurement of free T4, TSH, and antithyroid antibodies (TPOAb and TgAb) was assayed using commercial kits. The cases of hypothyroidism obtained were compared with those in another group of similar patients, diagnosed with diabetes mellitus type 2, through χ2 test. A total of 15 (26.78%) patients of 56 with ES had autoimmune thyroid disease (subclinical or clinical hypothyroidism). Primary hypothyroidism with negative antithyroid autoantibodies was found in a further 13 patients (23.21%). The 46.42% of ES had primary hypothyroidism; this result had obtained a statistically significant difference when compared to the ratio obtained in the group of diabetes mellitus type 2 (P < 0.0029). There is an important association between ES and autoimmune thyroid disease, which reached 26.78% in our series. We suggest the possibility of a common pathogenesis for certain cases of ES and autoimmune thyroid disease, with the end point of ES in the pituitary, and atrophy in the thyroid gland.

Keywords

Empty sella syndrome Hypothyroidism Autoimmune diseases 

Notes

Conflict of interest statement

Every author has participated sufficiently in the work to take public responsibility for its content.

References

  1. 1.
    Busch W (1951) Morphology of sella turcica and its relation to the pituitary gland. Virchows Arch 320:437–458CrossRefPubMedGoogle Scholar
  2. 2.
    Neelon FA, Goree JA, Lebovitz HE (1973) The primary empty sella: clinical and radiographic characteristics and endocrine function. Medicine (Baltimore) 52:73–92Google Scholar
  3. 3.
    Jordan RM, Kendall JW, Kerber CW (1977) The primary empty sella syndrome: analysis of the clinical characteristics, radiographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone concentrations. Am J Med 62:569–580CrossRefPubMedGoogle Scholar
  4. 4.
    Jawadi MH, Ballonoff LB, Stears JC, Katz FH (1978) Primary hypothyroidism and pituitary enlargement. Radiological evidence of pituitary regression. Arch Intern Med 138:1555–1557CrossRefPubMedGoogle Scholar
  5. 5.
    Okuno T, Sudo M, Momoi T, Takao T, Ito M, Konishi Y, Yoshioka M, Suzuki J, Nakano Y (1980) Pituitary hyperplasia due to hypothyroidism. J Comput Assist Tomogr 4:600–602PubMedCrossRefGoogle Scholar
  6. 6.
    Plehwe WE, Fabinyi GC (2003) Anterior pituitary hyperplasia due to primary autoimmune hypothyroidism. J Clin Neurosci 10:217–218CrossRefPubMedGoogle Scholar
  7. 7.
    Samaan NA, Stepanas AV, Danziger J, Trujillo J (1979) Reactive pituitary abnormalities in patients with Klinefelter’s and Turner’s syndromes. Arch Intern Med 139:198–201CrossRefPubMedGoogle Scholar
  8. 8.
    Riedl S, Frisch H (1997) Pituitary hyperplasia in a girl with gonadal dysgenesis and primary hypothyroidism. Horm Res 47:126–130CrossRefPubMedGoogle Scholar
  9. 9.
    Klein J, Fehm HL (2005) Unusual presentation of hypophysitis preceding an empty sella in a 75-year-old woman. Neuro Endocrinol Lett 26:757–758PubMedGoogle Scholar
  10. 10.
    Jara AA, Bayort FFJ, Iglesias RT, Benito C, Palacios Mateos JM (1975) Empty sella turcica syndrome and Addison’ disease: 2 cases. Rev Clin Esp 139:183–187Google Scholar
  11. 11.
    Ortega L, Jara-Albarran VA, Zapata J, Alvarez HJ (1984) Empty sella turcica associated with Addison’s disease and early menopause. Med Clin (Barc) 83:547–549Google Scholar
  12. 12.
    Novoa MFJ, Carrillo DA, Puigdevall G, Lopezd VV, Mendoza BB, Betancor LP (1989) Type II autoimmune polyglandular syndrome associated with empty sella turcica. An Med Interna 6:89–91Google Scholar
  13. 13.
    Jara-Albarran A, Bayort J, De Juan M, Benito C (1984) Spontaneous partial empty sella: a study of 41 cases. Exp Clin Endocrinol 83:63–72CrossRefPubMedGoogle Scholar
  14. 14.
    Bianconcini G, Bragagni G, Bianconcini M (1999) Primary empty sella syndrome. Observations on 71 cases. Recent Prog Med 90(7):3–80Google Scholar
  15. 15.
    Jara-Albarran A, Jara A (2001) Síndromes con silla turca vacía. In: Jara A (ed) Endocrinología. Ed. Médica Panamericana, Madrid, pp 109–114Google Scholar
  16. 16.
    Cannavo S, Curto L, Venturino M, Squadrito S, Almoto B, Narbone MC, Rao R, Trimarchi F (2002) Abnormalities of hypothalamic-pituitary-thyroid axis in patients with primary empty sella. J Endocrinol Invest 25:236–239PubMedGoogle Scholar
  17. 17.
    Milosevic M, Stojanovic M, Nesovic M (2005) Primary hypothyroidism associated with empty sella turcica and hypopituitarism. Med Pregl 58:410–413CrossRefPubMedGoogle Scholar
  18. 18.
    Hashimoto K, Yamakita N, Ikeda T, Matsuhisa T, Kuwayama A, Sano T, Hashimoto K, Yasuda K (2006) Longitudinal study of patients with idiopathic isolated TSH deficiency: possible progression of pituitary dysfunction in lymphocytic adenohypophysitis. Endocr J 53:593–601CrossRefPubMedGoogle Scholar
  19. 19.
    Young M, Kattner K, Gupta K (1999) Pituitary hyperplasia resulting from primary hypothyroidism mimicking macroadenomas. Br J Neurosurg 13:138–142CrossRefPubMedGoogle Scholar
  20. 20.
    Gup RS, Sheeler LR, Maeder MC, Tew JM Jr (1982) Pituitary enlargement and primary hypothyroidism: a report of two cases with sharply contrasting outcomes. Neurosurgery 11:792–794CrossRefPubMedGoogle Scholar
  21. 21.
    Bilaniuk LT, Moshang T, Cara J, Weingarten MZ, Sutton LN, Samuel LR, Zimmerman RA (1985) Pituitary enlargement mimicking pituitary tumor. J Neurosurg 63:39–42CrossRefPubMedGoogle Scholar
  22. 22.
    Kelestimur F, Selcuklu A, Ozcan N (1992) Empty sella developing during thyroxine therapy in a patient with primary hypothyroidism and hyperprolactinaemia. Postgrad Med J 68:589–591CrossRefPubMedGoogle Scholar
  23. 23.
    Guerrero LA, Carnovale R (1983) Regression of pituitary tumor after thyroid replacement in primary hypothyroidism. South Med J 76:529–531PubMedGoogle Scholar
  24. 24.
    Poretsky L, Garber J, Kleefield J (1986) Primary amenorrhea and pseudoprolactinoma in a patient with primary hypothyroidism. Reversal of clinical, biochemical, and radiologic abnormalities with levothyroxine. Am J Med 81:180–182CrossRefPubMedGoogle Scholar
  25. 25.
    Ahmed M, Banna M, Sakati N, Woodhouse N (1989) Pituitary gland enlargement in primary hypothyroidism: a report of 5 cases with follow-up data. Horm Res 32:188–192CrossRefPubMedGoogle Scholar
  26. 26.
    Ozbey N, Sariyildiz E, Yilmaz L, Orhan Y, Sencer E, Molvalilar S (1997) Primary hypothyroidism with hyperprolactinaemia and pituitary enlargement mimicking a pituitary macroadenoma. Int J Clin Pract 51:409–411PubMedGoogle Scholar
  27. 27.
    Kocova M, Netkov S, Sukarova-Angelovska E (2001) Pituitary pseudotumor with unusual presentation reversed shortly after the introduction of thyroxine replacement treatment. J Pediatr Endocrinol Metab 14:1665–1669PubMedGoogle Scholar
  28. 28.
    Khawaja NM, Taher BM, Barham ME, Naser AA, Hadidy AM, Ahmad AT, Hamamy HA, Yaghi NA, Ajlouni KM (2006) Pituitary enlargement in patients with primary hypothyroidism. Endocr Pract 12:29–34PubMedGoogle Scholar
  29. 29.
    Danziger J, Wallace S, Handel S, Samaan NB (1979) The sella turcica in primary end organ failure. Radiology 131:111–115PubMedGoogle Scholar
  30. 30.
    Nishi Y, Sakano T, Hyodo S, Masuda H, Kitamura Y, Shindo H, Sakoda K, Uozumi T, Usui T (1984) Pituitary abnormalities detected by high resolution computed tomography with thin slices in primary hypothyroidism and Turner syndrome. Eur J Pediatr 142:25–28CrossRefPubMedGoogle Scholar
  31. 31.
    Fujii T, Misumi S, Onoda K, Fukuda H, Ibuki Y (1987) Pituitary enlargement with target organ deficiency: hypothyroidism and hypogonadism. Surg Neurol 28:390–394CrossRefPubMedGoogle Scholar
  32. 32.
    Atchison JA, Lee PA, Albright AL (1989) Reversible suprasellar pituitary mass secondary to hypothyroidism. JAMA 262:3175–3177CrossRefPubMedGoogle Scholar
  33. 33.
    Nicholas WC, Russell WF (2000) Primary hypothyroidism presenting as a pituitary mass. J Miss State Med Assoc 41:511–514PubMedGoogle Scholar
  34. 34.
    Bhansali A, Sreenivasulu P, Khandelwal N, Masoodi SR (2004) Reversibility of thyrotroph hyperplasia after l-thyroxine replacement therapy in patients with juvenile primary hypothyroidism. J Pediatr Endocrinol Metab 17:655–661PubMedGoogle Scholar
  35. 35.
    Joshi AS, Woolf PD (2005) Pituitary hyperplasia secondary to primary hypothyroidism: a case report and review of the literature. Pituitary 8:99–103CrossRefPubMedGoogle Scholar
  36. 36.
    Hopper NW, Albanese A (2005) Primary hypothyroidism in a child mimicking a pituitary macroadenoma. Horm Res 63:61–64CrossRefPubMedGoogle Scholar
  37. 37.
    Ashley WW Jr, Ojemann JG, Park TS, Wippold FJ (2005) Primary hypothyroidism in a 12-year-old girl with a suprasellar pituitary mass: rapid regression after thyroid replacement therapy: case report. J Neurosurg 102:413–416PubMedGoogle Scholar
  38. 38.
    Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007) Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999–2002). Thyroid 17:1211–1223CrossRefPubMedGoogle Scholar
  39. 39.
    Surks MI, Hollowell JG (2007) Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab 92:4575–4582CrossRefPubMedGoogle Scholar
  40. 40.
    Arrigo T, Wasniewska M, Crisafulli G, Lombardo F, Messina MF, Rulli I, Salzano G, Valenzise M, Zirilli G, De Luca F (2008) Subclinical hypothyroidism: the state of the art. J Endocrinol Invest 31:79–84PubMedGoogle Scholar
  41. 41.
    Goudie RB, Pinkerton PH (1962) Anterior hypophysitis and Hashimoto’s disease in a young woman. J Pathol Bacteriol 83:584–585CrossRefPubMedGoogle Scholar
  42. 42.
    Ozawa Y, Shishiba Y (1993) Recovery from lymphocytic hypophysitis associated with painless thyroiditis: clinical implications of circulating antipituitary antibodies. Acta Endocrinol (Copenh) 128:493–498Google Scholar
  43. 43.
    Paja M, Estrada J, Ojeda A, Cajal S, Garcia-Uria J, Lucas T (1994) Lymphocytic hypophysitis causing hypopituitarism and diabetes insipidus, and associated with autoimmune thyroiditis, in a non-pregnant woman. Postgrad Med J 70:220–224CrossRefPubMedGoogle Scholar
  44. 44.
    Hashimoto K, Takao T, Makino S (1997) Lymphocytic adenohypophysitis and lymphocytic infundibuloneurohypophysitis. Endocr J 44:1–10CrossRefPubMedGoogle Scholar
  45. 45.
    Barbaro D, Loni G (2000) Lymphocytic hypophysitis and autoimmune thyroid disease. J Endocrinol Invest 23:339–340PubMedGoogle Scholar
  46. 46.
    Manetti L, Lupi I, Morselli LL, Albertini S, Cosottini M, Grasso L, Genovesi M, Pinna G, Mariotti S, Bogazzi F, Bartalena L, Martino E (2007) Prevalence and functional significance of antipituitary antibodies in patients with autoimmune and non-autoimmune thyroid diseases. J Clin Endocrinol Metab 92:2176–2181CrossRefPubMedGoogle Scholar
  47. 47.
    De Rosa G, Della CS, Corsello SM, Cecchini L, Calla C (1987) Autoimmune polyglandular syndrome, primary empty sella, and acute lymphocytic leukaemia. Clin Endocrinol (Oxf) 27:535–543CrossRefGoogle Scholar
  48. 48.
    Matta MP, Kany M, Delisle MB, Lagarrigue J, Caron PH (2002) A relapsing remitting lymphocytic hypophysitis. Pituitary 5:37–44CrossRefPubMedGoogle Scholar
  49. 49.
    Komatsu M, Kondo T, Yamauchi K, Yokokawa N, Ichikawa K, Ishihara M, Aizawa T, Yamada T, Imai Y, Tanaka K (1988) Antipituitary antibodies in patients with the primary empty sella syndrome. J Clin Endocrinol Metab 67:633–638CrossRefPubMedGoogle Scholar
  50. 50.
    Mau M, Phillips TM, Ratner RE (1993) Presence of anti-pituitary hormone antibodies in patients with empty sella syndrome and pituitary tumours. Clin Endocrinol (Oxf) 38:495–500CrossRefGoogle Scholar
  51. 51.
    Diez JJ, Sánchez P, Fernández-Vázquez G, Iglesias P (2007) Prevalence of thyroid dysfunction in patients with type 2 diabetes. 89th Annual Meeting Endocrine Society, TorontoGoogle Scholar
  52. 52.
    Takao T, Asaba K, Tanaka H, Matsumoto R, Nanamiya W, Hashimoto K (2000) A case of lymphocytic infundibuloneurohypophysitis showing diabetes insipidus followed by anterior hypopituitarism associated with thrombasthenia. Endocr J 47:285–291CrossRefPubMedGoogle Scholar
  53. 53.
    De Bellis A, Bizzarro A, Conte M, Perrino S, Coronella C, Solimeno S, Sinisi AM, Stile LA, Pisano G, Bellastella A (2003) Antipituitary antibodies in adults with apparently idiopathic growth hormone deficiency and in adults with autoimmune endocrine diseases. J Clin Endocrinol Metab 88:650–654CrossRefPubMedGoogle Scholar
  54. 54.
    O’Dwyer DT, Smith AI, Matthew ML, Andronicos NM, Ranson M, Robinson PJ, Crock PA (2002) Identification of the 49-kDa autoantigen associated with lymphocytic hypophysitis as alpha-enolase. J Clin Endocrinol Metab 87:752–757CrossRefPubMedGoogle Scholar
  55. 55.
    Rivera JA (2006) Lymphocytic hypophysitis: disease spectrum and approach to diagnosis and therapy. Pituitary 9:35–45CrossRefPubMedGoogle Scholar
  56. 56.
    Ruelle A, Bernasconi D, Tunesi G, Andrioli G (1999) Lymphocytic hypophysitis: case report. J Neurosurg Sci 43:205–208PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Rogelio García-Centeno
    • 1
  • José Pablo Suárez-Llanos
    • 1
  • Elisa Fernández-Fernández
    • 1
  • Victor Andía-Melero
    • 1
  • Petra Sánchez
    • 1
  • Antonino Jara-Albarrán
    • 1
  1. 1.Department of EndocrinologyHospital General Universitario Gregorio MarañónMadridSpain

Personalised recommendations