How Common is Empty Sella Turcica in Middle-Aged, Often Multiparous Women?
Empty sella turcica is extremely common in this demographic, occurring in approximately 8-35% of the general population, with a striking 5:1 female-to-male predominance, and is particularly prevalent in middle-aged, obese, hypertensive women with multiple pregnancies. 1
Prevalence in the General Population
The reported prevalence varies considerably depending on the study methodology:
- General population estimates range from 2% to 20%, though technical advances in neuroimaging have made this an increasingly common incidental finding 2
- Autopsy series suggest even higher rates, with empty sella of normal size being a frequent and probably normal finding in unselected autopsy populations 3
- Clinical series typically report 8-35% prevalence in the general population 1
Demographic Profile: The Classic Patient
The typical patient with primary empty sella fits a very specific profile:
- Middle-aged women represent the overwhelming majority, with mean age at diagnosis of 48.2 ± 14 years 4
- Female-to-male ratio is 5:1, making this condition five times more common in women 1
- Multiple pregnancies are present in 58.3% of affected women, establishing multiparity as a key risk factor 4
Associated Clinical Features
Beyond the demographic pattern, certain clinical characteristics cluster with empty sella:
- Obesity is present in 49.5% of patients 4
- Hypertension affects 27.3% of patients 4
- Headaches occur in 59.4% of cases, though these should not be attributed directly to the empty sella itself, as it is usually an incidental finding unrelated to headache symptoms 5, 4
Clinical Context: Why This Matters
Understanding the high prevalence in this demographic is crucial because:
- Most cases (33.1%) are discovered during evaluation of headache, though the empty sella itself is typically not the cause 4
- Approximately 30% of patients demonstrate some degree of hypopituitarism upon testing, though most remain asymptomatic 5, 6
- In clinical series, 28% of patients had some degree of hypopituitarism overall, with a notable gender difference: 64% in males versus only 22% in females 4
Important Clinical Caveat
The high prevalence in middle-aged multiparous women should not lead to complacency about hormonal screening. Despite the benign nature of most cases, comprehensive hormonal evaluation is mandatory regardless of symptoms, as affected-axis rates often exceed 10% and may reach 50% 5. The discrepancy between high prevalence and relatively low clinical recognition suggests many cases remain undiagnosed or underinvestigated 2.