Empty Sella Syndrome

The usual course of untreated acromegaly is a gradual but progressive worsening of acral enlargement, arthritis, and cardiovascular disease that ultimately results in early death.1However, occasionally individuals with acromegaly will report the spontaneous remission of symptoms without therapy.2,3Prior to the development of specific and sensitive radioimmunoassays for growth hormone, this clinical syndrome of "burned out acromegaly" was thought to reflect the spontaneous cessation of growth hormone secretion by a previously functioning tumor. However, with the advent of suitable hormone assays, it became apparent that such patients frequently continued to secrete large amounts of growth hormone, even though the clinical signs and symptoms of acromegaly had apparently diminished. True spontaneous remission of the metabolic features of acromegaly, verified by appropriate measurements of growth hormone, has been reported in only six cases3-8and the mechanisms involved are incompletely understood. For these reasons, it appeared pertinent to describe