Empty sella and primary autoimmune hypothyroidism
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.
KeywordsEmpty sella syndrome Hypothyroidism Autoimmune diseases
Conflict of interest statement
Every author has participated sufficiently in the work to take public responsibility for its content.
- 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
- 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.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.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
- 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.Jara-Albarran A, Jara A (2001) Síndromes con silla turca vacía. In: Jara A (ed) Endocrinología. Ed. Médica Panamericana, Madrid, pp 109–114Google Scholar
- 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
- 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
- 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
- 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
- 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