Empty sella syndrome

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Empty sella syndrome
MRI showing empty sella
Synonyms
Pronounce	N/A
Specialty	N/A
Symptoms	Headache, vision problems, hormonal imbalances
Complications	Hypopituitarism, cerebrospinal fluid leak
Onset
Duration
Types	Primary, Secondary
Causes	Congenital, trauma, surgery, radiation therapy
Risks	Obesity, hypertension
Diagnosis	MRI, CT scan
Differential diagnosis	Pituitary adenoma, arachnoid cyst
Prevention
Treatment	Hormone replacement therapy, surgery
Medication
Prognosis	Generally good with treatment
Frequency
Deaths

Empty sella syndrome (ESS) is a medical condition characterized by the presence of a sella turcica that appears to be empty. The sella turcica is a saddle-shaped depression in the sphenoid bone at the base of the skull, which houses the pituitary gland. In ESS, the pituitary gland is either shrunken or flattened, making the sella turcica appear empty on imaging studies.

Classification

Empty sella syndrome is classified into two types:

• Primary empty sella syndrome: This occurs when a defect in the diaphragma sellae, a small membrane that covers the sella turcica, allows cerebrospinal fluid (CSF) to enter the sella and compress the pituitary gland.
• Secondary empty sella syndrome: This form occurs when the pituitary gland is damaged due to surgery, radiation therapy, pituitary apoplexy, or other conditions that affect the gland.

Symptoms

Many individuals with empty sella syndrome are asymptomatic and the condition is often discovered incidentally during imaging studies for other reasons. When symptoms do occur, they may include:

• Headache
• Visual disturbances
• Hypopituitarism (deficiency of one or more pituitary hormones)
• Hyperprolactinemia (elevated levels of prolactin)

Diagnosis

The diagnosis of empty sella syndrome is typically made through imaging studies such as:

• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan

Treatment

Treatment for empty sella syndrome depends on the presence and severity of symptoms. Asymptomatic individuals usually do not require treatment. Symptomatic treatment may include:

• Hormone replacement therapy for hypopituitarism
• Management of headaches and visual disturbances

Prognosis

The prognosis for individuals with empty sella syndrome is generally good, especially for those who are asymptomatic. Regular monitoring and follow-up are recommended for those with hormone deficiencies or other complications.

See also

• Pituitary gland
• Hypopituitarism
• Hyperprolactinemia
• Sella turcica
• Cerebrospinal fluid
• Magnetic resonance imaging
• Computed tomography