Hypopituitarism or hyperpituitarism? Empty sella combined with Cushing disease: a case report and literature review

Abstract Purpose We aimed to describe and emphasize the qualitative and etiological diagnosis of Cushing disease combined with empty sella. Methods We reported a 54 y/o female patient who was diagnosed as Cushing syndrome and was qualitatively diagnosed as Cushing disease through endocrine function test. However, the first enhanced MRI examination only found the empty sella. The consistent results of all endocrine function tests led us to conduct the second enhanced MRI of pituitary microadenomas and finally found pituitary nodules on the background of empty sella after careful analysis of imaging films. Finally, the patient accepted surgical treatment and was followed up well. Conclusion The empty sella is not necessarily all hypopituitarism, and it may be hyperpituitarism or both in some cases. Standardized endocrine function tests and advanced imaging technology can play decisive roles for qualitative and etiological diagnosis.