Empty Sella Turcica Syndrome: About a Case Revealed by Adrenal Insufficiency

Background: Empty sella turcica corresponds to an arachnocele which may be complete or partial, primary or secondary. The primary form is rarer. Its cause is unknown, but etiological factors have been identified. The prevalence of this condition is variable, depending on techniques of diagnosis. It may be detected fortuitously on imaging or in the presence of neurological, ocular or endocrine manifestations. Aim: We aim to report a case of empty sella turcica syndrome revealed by adrenal insufficiency in a young African black woman. Case presentation: It was an overweight young woman with signs of intracranial hypertension associated with central adrenal insufficiency. The diagnosis of empty sella was confirmed by magnetic resonance imaging. Secondarily, she developed a hypo metabolism syndrome and biology confirmed central hypothyroidism. After correction of the adrenal cortical deficit, the treatment of the thyroid deficit was administered. Evolution was favourable clinically and biologically. Conclusion: The empty sella turcica is rare and its revelation by a central adrenal insufficiency is even more. The case we report is a perfect illustration.

Computed Tomography Assessment of Cephalic Index and Sella Turcica Dimensions and Morphology in a Nigerian Population

Cephalic index(CI)is the percentage of biparietal diameter to the occipitofrontal diameter of the skull and can be used in forensic investigations in cases of disputed identity where only fragments of the head/skull are available.The sella turcica houses the pituitary gland whose hormones regulate the functions of many other glands and systems of the body.Abnormal sizes of sella turcica could indicate sella/pituitary pathology with health implications.This study aimed to assess CI,head shapes and sella turcica dimensions and morphology of the Yoruba tribe of Nigeria.The objectives are:to relate CI and head shapes with sella turcica dimensions and morphology,to use CI and head shape to identify and distinguish the Yoruba tribe from other tribes,to use CI and head shape to distinguish between genders.Skull/head and sella turcica dimensions were measured on 321 retrospectively enlisted normal cranial Computed Tomography(CT)images of Yoruba subjects,mean age 55(SD±17)years,in a Tertiary Hospital in South-West Nigeria between January 2020 and April 2021,and then CI calculated.Data was analyzed using IBM SPSS 27(IBM Corp.Armonk,NY,USA,2019).Predominant head shape of the studied group was dolichocephalic.Mean CI was 70.0±3.7 and showed no statistically significant difference between gender(P=0.097).Mean sella length,depth;and anteroposterior diameter was 1.22±0.24 cm,0.80±0.15 cm,1.34±0.25 cm respectively.Mean sella length and depth showed significant difference between gender(P=0.0001;P=0.032)respectively.Head shape has no association with sella dimensions and morphology.Head shape and CI may stratify populations in forensic practice and surgical planning.

Intrasellar cavernous hemangioma: A case report and literature review

Intrasellar cavernous hemangioma is rare. There are no specific symptoms and the mass effect often mimics pituitary macroadenoma. We present one case of intrasellar cavernous hemangioma that was misdiagnosed. Progressively decreasing vision was the main symptom in this case. The prolactin level was mildly increased but other biochemistry examinations were normal. Magnetic resonance imaging showed an enlarged pituitary fossa and an irregular solid tumor(33 mm × 22 mm × 22 mm) in the sella turcica and parasellar region. Subtotal removal in the case was performed through a transsphenoidal approach. Postoperatively, the patient's visual acuity improved. Through a literature review of 8 intrasellar cavernous hemangiomas, we found most lesions are likely to extend into the suprasellar cistern and cavernous sinus, and total resection is difficult. Transsphenoidal approach surgery should be applied for decompression of the optic nerve and biopsy, and stereotactic radiosurgery is preferable.