Partially empty sella, oophorectomy

31-year-old lady for Hysteroscopy, D&C, Ablation, and Laparoscopic Bilateral Oophorectomy


  • Chronic pelvic pain, recurrent ovarian cysts
  • Menorrhagia and anaemia, known to Gynaecologist for many years
  • Multiple previous hysteroscopies and laparoscopies
  • Decision to have oophorectomy made the day prior to clinic review via preoperative phoneconsult with proceduralist
  • Recent referral to chronic pain specialist, review pending


  • Partially Empty Sella syndrome – ACTH, TSH, and Prolactin deficiency
  • On high-dose Hydrocortisone
  • Previous Addisonian crisis perioperatively despite steroid replacement regime?
  • Hypothyroidism
  • Severe untreated GORD
  • Procedure booked for private hospital with no onsite endocrinology support
  • Very fit and healthy lady despite co-morbidities. DASI >10


What is Partially Empty Sella?

  • Empty sella – Radiological description. Pituitary gland shrinks/is compressed by CSF making the sella look empty.
  • Partial empty sella – remnants of the pituitary gland visible on MRI
  • Rare condition, congenital. Mainly affects women
  • Hypopituitarism – mainly deficiencies of anterior pituitary hormones.
  • Common manifestations are Central hypogonadism and female infertility.

Perioperative management of Addison’s

  • Maintain hydration and regular steroid replacement
  • Monitor electrolytes and BSL


  • IV hydrocortisone replacement at start of surgery – dose dependent on surgery and duration of fasting
  • IV hydrocortisone replacement in first 24 hours after intermediate and major surgery
  • Endocrinologist advice recommended. See attached BJA education paper

Suitable for Private Hospital?

  • Consensus was no, surgery should be rescheduled to occur at JHH
  • Endocrinologist in agreement, should be in hospital where they are available to consult
  • Proceed at JHH
  • Steroid replacement regime in conjunction with endocrine
  • Recheck pathology including TFT’s
  • Commence PPI
  • See article Anaesthesia and Pituitary Disease doi:10.1093/bjaceaccp/mkr014