The rate of empty sella (ES) in traumatic brain injury: links with endocrine profiles

Empty sella is a frequent incidental finding during performance of brain radiological imaging for other reasons than looking for pituitary abnormalities. It is reported in approximately 2-38% of patients upon radiological examination, and it does not necessarily indicate presence of pituitary insufficiency or disease requiring treatment. Empty sella can be primary or secondary to a specific pathological process and can be seen after traumatic brain injury. It has been suggested to be an indicator of post-traumatic hypopituitarism in some studies. Although post-traumatic hypopituitarism should not be confused with stress-related endocrine alterations especially in the acute and early post-acute phase, neither should severe hypopituitarism be overlooked as potentially lethal if left untreated in case of central adrenal insufficiency. Treatment indication in less severe cases may however also exist. Growth hormone deficiency is the most common endocrine complication occurring after head trauma. The decision to treat post-traumatic pituitary insufficiency relies on a correct diagnosis of the various hormone insufficiencies, and the order of commencement of treatment of multiple hormones is usually adrenal, thyroid, sex hormones and finally growth hormone.