Overdiagnosis is Stressful
In stark contrast to our experience, this article emphasizes that empty sella needs to be clarified (1). We thus carried out a retrospective ad hoc investigation of 100 patient cases from our practice (using data of scans taken from 15–26 February, 2018). The inclusion criterion was having a magnetic resonance imaging of the skull for any indication except pituitary disease. The craniocaudal heights of the sella turcica and the pituitary gland were measured on the T1-weighted sagittal images, and the percentage of the sella that was filled was calculated.
On average, the patients in this analysis were 54 years old (15–90) and 55% of them were female. The average height of the pituitary gland was 4.52 mm (95% confidence interval [CI]: [4.3; 4.8]), and on average 66% [62; 70] of the sella was filled. The height of the pituitary decreased with age (Pearson correlation coefficient –0.2; p <0.001). Thirteen of the 100 patients who had no clinical signs of hormonal abnormality had a filling of less than 50% and thus would have been diagnosed with a complete empty sella, according to the definition of this article, while by definition 80 patients had a partial empty sella.
How could one explain the discrepancy between our data and the article?
1. The definition of empty sella syndrome by Auer et al. (1) is problematic: in our case, it would mean that 80% of our patients had partial empty sella.
2. In contrast to us, Auer et al. analyzed highly selected populations from departments of endocrinology at university hospitals (2, 3). However, the pretest probability (prevalence of the disease sought) influences the relevance of test results.
In summary, we consider the recommendation for intensive hormone diagnostics for the frequently occurring empty sella to be problematic, as overdiagnosis is expensive and potentially harmful to patients.
Prof. Dr. med. Wolfgang Freund
Dr. med. Thomas Nonn
88400 Biberach, Germany
PD Dr. med. Frank Weber
82256 Fürstenfeldbruck, Germany
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Auer MK, Stieg MR, Crispin A, Sievers C, Stalla GK, Kopczak A: Primary empty sella syndrome and the prevalence of hormonal dysregulation—a systematic review. Dtsch Arztebl Int 2018; 115: 99–105 VOLLTEXT|
|2.||de Marinis L, Bonadonna S, Bianchi A, Maira G, Giustina A: Primary empty sella. J Clin Endocrinol Metab 2005; 90: 5471–7 CrossRef MEDLINE|
|3.||Lupi I, Manetti L, Raffaelli V, et al.: Pituitary autoimmunity is associated with hypopituitarism in patients with primary empty sella. J Endocrinol Invest 2011; 34: e240–4 MEDLINE|