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Primary empty sella (PES) is a rare condition characterized by the herniation of the subarachnoid space into the sellaturcica, with variable filling of cerebrospinal fluid (CSF). We present a clinical case of a 19-year-old male with primary partial empty sella who presented with hypogonadotropic hypogonadism, a condition typically observed in females at an older age. The patient exhibited delayed puberty with characteristic hormonal abnormalities and bilateral atrophic testicles. Magnetic resonance imaging (MRI) revealed a partial empty sella with preserved pituitary function. Hormonal replacement therapy was initiated, leading to improved virilization however, fertility induction was unsuccessful despite intervention. The etiology of PES remains unclear, with proposed mechanisms involving sellar and pituitary factors. Genetic studies have identified candidate genes associated with PES development. Hormonal replacement therapy remains the cornerstone of treatment, aiming to alleviate symptoms and prevent long-term complications. This case underscores the importance of early recognition and management of hypogonadotropic hypogonadism in male patients with PES, with consideration for comprehensive therapeutic approaches, including fertility induction where appropriate.
Ismail et al. (Wed,) studied this question.