Objective: To report 5 cases of empty sella syndrome (ESS) manifesting with various degrees of pituitary dysfunction.
Methods: We describe the initial manifestations in 5 patients with primary ESS and in previous cases of ESS reported in the English language literature.
Results: Review of our recent medical records identified 5 patients referred for evaluation of pituitary deficiencies in whom ESS was diagnosed. Glucocorticoid replacement was required in 3 patients, 2 of whom presented initially with symptoms of severe glucocorticoid deficiency. In each case, magnetic resonance imaging of the brain demonstrated an empty sella.
Conclusion: Our cases suggest that endocrine abnormalities are not rare as the initial manifestation of ESS and that, contrary to many studies in the literature, the endocrine abnormalities may be quite severe.