Disparities in the Quality of Care in Patients with Empty Sella Based on Etiology: A Cross-Sectional Study from Saudi Arabia

Background Empty sella (ES) is characterized by the replacement of pituitary tissue with cerebrospinal fluid (CSF) in the sella turcica. Despite its frequency in clinical settings, ES is often underrecognized and incompletely evaluated. The aim of this study was to examine patterns of care and potential disparities across different ES etiologies. Methods This retrospective cross-sectional study aimed to evaluate differences in hormonal assessment and referral patterns among patients with various etiologies of empty sella. All patients aged ≥14 years diagnosed with ES between February 2021 and December 2022 at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, were included. Relevant data were extracted from electronic medical records, and comparisons of hormonal assessment were made based on etiology and reason for endocrine referral. Results Among 287 patients (75.3% female, mean age 49.7 years), 84.6% had primary ES. Only 29.9% were referred to endocrinology (52.4% for ES-specific evaluation). Secondary ES patients received more comprehensive hormonal assessments than primary ES ( P <0.001). Primary ES referrals for ES-specific evaluation correlated with thorough testing ( P <0.001). Conclusions Significant disparities exist in ES management, driven by etiology and referral intent. Standardized referral pathway and universal screening are essential to improve care.