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Neurology (Expert Forum)
Enlarged Empty Sella
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Enlarged Empty Sella
by nancy, Dec 12, 1999 12:00AM
Hello,
I am F/42, 5', 135 pounds.
For many years I have suffered with extreme headaches
(normal cat scan in 1981), body aches,numbness(falling asleep)in right hand, wrist, arm, right hip, leg, and feet. pain in: shoulders, back, hips, legs, right arm, wrist, hands and fingers.
sleep problems, tired all the time. Weight problems, eating disorders. I was diagnosed with Leggionella(sp) in 1994 while in the hospital, almost died, miracle...I recovered.
TESTS: EMG's normal, x-rays normal, arthritic panels normal.
Just discovered enlarged empty sella, see below.
X-RAYS: Shoulder/normal, Lumbar/normal.
KNOWN DISEASES: Hypothyroid diagnosed 1973, hyperlipds 1982,
Degenerative disks/bulging in L4-L5 and S1 (all <5mm)1994, TMJ,
20 yrs sever depression.
SURGERIES: Hysterectomy/pre-cancer, ovaries removed/Lg cysts/scar tissue, gallbladder/ 3/4 full of stones, Deviated septum w/removal of subturbinates, Failed repair of deviated septum, Bladder repair/lift, 4 c-sections.
X-RAY RESULTS: Abnormal Sella Turcica
Ballooning of the floor anteriorly, and erosion of the Dorsum
posteriorly - consistent with Intra Sella Tumor or Adenoma.
Suggest: MRI pre and post gado
FIRST IMPRESSION of MRI was: 1. Enlarged empty sella 16mm AP, 16mm Trans & 10mm cc (-) for tumor 2. Abnormal MRI of Brain.
FINAL REPORT of MRI: MRI of the Brain and Pituitary Gland
(pre and post contrast) The Pituitary fossa was imaged in
the coronal and sagittal plane via spin echo T1-weighted
sequences obtained before and after intravenous gadolinium.
FINDINGS: Review of the pulse sequences obtained reveals an
enlarged empty sella which measures approx. 16 mm AP, 16 mm transversely and 10 mm craniocaudally. The pituitary gland is compressed against the floor and the posterior aspect of the sella. The optic chiasm and the pituitary stalk are unremarkable.
IMPRESSION: Enlarged Empty Sella measuring 16 mm AP, 16mm transversely and 10 mm craniocaudally. The pituitary gland is displaced or compressed into the floor and posterior aspect of the sella.
Essentially normal MRI of the brain.
I am so frustrated. Do you have any advice for me?
Do I keep seeking help for all my pain and problems?
Can any of this be related to one another?
Thank you so much in advance,
Nancy
I am F/42, 5', 135 pounds.
For many years I have suffered with extreme headaches
(normal cat scan in 1981), body aches,numbness(falling asleep)in right hand, wrist, arm, right hip, leg, and feet. pain in: shoulders, back, hips, legs, right arm, wrist, hands and fingers.
sleep problems, tired all the time. Weight problems, eating disorders. I was diagnosed with Leggionella(sp) in 1994 while in the hospital, almost died, miracle...I recovered.
TESTS: EMG's normal, x-rays normal, arthritic panels normal.
Just discovered enlarged empty sella, see below.
X-RAYS: Shoulder/normal, Lumbar/normal.
KNOWN DISEASES: Hypothyroid diagnosed 1973, hyperlipds 1982,
Degenerative disks/bulging in L4-L5 and S1 (all <5mm)1994, TMJ,
20 yrs sever depression.
SURGERIES: Hysterectomy/pre-cancer, ovaries removed/Lg cysts/scar tissue, gallbladder/ 3/4 full of stones, Deviated septum w/removal of subturbinates, Failed repair of deviated septum, Bladder repair/lift, 4 c-sections.
X-RAY RESULTS: Abnormal Sella Turcica
Ballooning of the floor anteriorly, and erosion of the Dorsum
posteriorly - consistent with Intra Sella Tumor or Adenoma.
Suggest: MRI pre and post gado
FIRST IMPRESSION of MRI was: 1. Enlarged empty sella 16mm AP, 16mm Trans & 10mm cc (-) for tumor 2. Abnormal MRI of Brain.
FINAL REPORT of MRI: MRI of the Brain and Pituitary Gland
(pre and post contrast) The Pituitary fossa was imaged in
the coronal and sagittal plane via spin echo T1-weighted
sequences obtained before and after intravenous gadolinium.
FINDINGS: Review of the pulse sequences obtained reveals an
enlarged empty sella which measures approx. 16 mm AP, 16 mm transversely and 10 mm craniocaudally. The pituitary gland is compressed against the floor and the posterior aspect of the sella. The optic chiasm and the pituitary stalk are unremarkable.
IMPRESSION: Enlarged Empty Sella measuring 16 mm AP, 16mm transversely and 10 mm craniocaudally. The pituitary gland is displaced or compressed into the floor and posterior aspect of the sella.
Essentially normal MRI of the brain.
I am so frustrated. Do you have any advice for me?
Do I keep seeking help for all my pain and problems?
Can any of this be related to one another?
Thank you so much in advance,
Nancy
Doctor's Answer
by CCF Neuro[P] MD, RPS, Dec 12, 1999 12:00AM
Dear Nancy:
What you describe is likely a congenital abnormality that you have had your whole like. The CT scan, unless the radiologist who read it was a neuroradiologist, would not have picked it up. The bones surrounding the pituitary in the sella give an artifact beaming that makes this diagnosis difficult on CT. Although you do have hypothyroid problem, it is obvious that the other parts of your pituitary are functioning okay as you have had several children, seem to produce ACTH, prolactin, ADH, etc. (the other pituitary hormones). It is doubtful that this has lead to all your problems mentioned. Certainly, a thyroid problem can give you many types of muscle and neuropathy problems but you are taking synthroid and that diagnosis of hypothyroid occurred many years ago. One never says never, but I really don't see your abnormality of the sella causing your problems.
I wish it were and that something could change the way you feel by just surgically correcting the pituitary placement. But surgery is likely not an option, difficult area to access surgically.
Sincerely,
CCF Neuro MD
What you describe is likely a congenital abnormality that you have had your whole like. The CT scan, unless the radiologist who read it was a neuroradiologist, would not have picked it up. The bones surrounding the pituitary in the sella give an artifact beaming that makes this diagnosis difficult on CT. Although you do have hypothyroid problem, it is obvious that the other parts of your pituitary are functioning okay as you have had several children, seem to produce ACTH, prolactin, ADH, etc. (the other pituitary hormones). It is doubtful that this has lead to all your problems mentioned. Certainly, a thyroid problem can give you many types of muscle and neuropathy problems but you are taking synthroid and that diagnosis of hypothyroid occurred many years ago. One never says never, but I really don't see your abnormality of the sella causing your problems.
I wish it were and that something could change the way you feel by just surgically correcting the pituitary placement. But surgery is likely not an option, difficult area to access surgically.
Sincerely,
CCF Neuro MD
please have a complete hormone level checked out
it is very possible that other levels would be low also, even if they were not low when you were younger
things can happen to the pituitary as you age that could create problems
i have even seen information that would link fms to a low growth
hormone level
for more information seek out www.pituitary.com
they can put you in touch with an endo that has knowledge of the pituitary (not every endo has enough knowledge of the pituitary to treat the poss. problem completely}
sending you well thoughts, try to rest when you can - it may help your pain level.
CCF Neuro MD
I am not sure what you want me to say. Sounds like you have alot of various problems, that may or may not all be related. I think what you need is one physician to manage what the others are telling you and try to formulate a plan so you can live your life the best way possible. The main issue sounds that you need to find a diagnosis for your symptoms. I am not sure what your doctors have told you and what tests have been performed. But, sometimes the tests and results do not allow the doctor to fully evaluate your illness (the forest and trees syndrome). Maybe if you gather all the information and seek another opinion from someone not familar with your case, something might turn up.
Sincerely,
CCF Neuro MD
I am so sorry I did not get back right away, and Thank You so much for responding to my query!
I saw a neurosurgen this last Friday. He gave me the same information that was posted from "CCF Neuro[P] MD, RPS on Sunday, December 12, 1999" and also added, almost the same advice/opinion as "lindy on Friday, December 17, 1999"!
I am being refered to a endo asap. And will be having a full pituitary work-up. I will keep in touch via comments.
A big "Thank you so much" :>
Nancy
CCF Neuro MD