The skull x-ray remains invaluable as a first step in the diagnosis of many endocrine disorders. Pituitary tumors commonly cause enlargement or distortion of the sella turcica, which can be seen on skull x-ray. Pinealomas and craniopharyngiomas may also be detected. Hyperparathyroidism can cause granular decalcification in the skull. Hypoparathyroidism produces calcification of the basal ganglia and cerebellum. Lesions due due to metastatic malignancies or eosinophilic granulomas may be noted in cases of diabetes insipidus. Sellar enlargement may be due to the "empty sella" syndrome. Twenty-five percent of all cases of enlarged sella may be accounted for by this syndrome.