Empty Sella Syndrome

Empty sella syndrome is a condition where the pituitary gland, a small gland at the base of your brain, appears flattened or shrunken. The bony space that normally holds this gland, called the sella turcica, then fills with cerebrospinal fluid. It is often discovered by chance during brain imaging for other reasons and usually does not cause significant health problems.

What is Empty Sella Syndrome?

Empty sella syndrome is a condition where the pituitary gland, a small gland at the base of your brain, appears flattened or shrunken. The bony space that normally holds this gland, called the sella turcica, then fills with cerebrospinal fluid (the fluid surrounding your brain and spinal cord). This condition is often found by accident during brain scans for other issues and typically does not cause health problems.

The sella turcica is a saddle-shaped bony structure located at the base of your skull. It normally cradles and protects the pituitary gland. The pituitary gland is a vital organ that produces many hormones, which control various body functions, including growth, metabolism, and reproduction. In empty sella syndrome, the sella turcica appears "empty" on imaging scans because the pituitary gland is flattened against the walls of the sella, and the space is filled with cerebrospinal fluid. It is important to know that the gland is still present, just not in its typical shape or position. There are two main types: primary and secondary empty sella syndrome. Primary empty sella syndrome occurs when there is no known cause. Secondary empty sella syndrome develops as a result of another medical condition, injury, or treatment. Most cases are primary and are usually harmless.

Symptoms

Most people with empty sella syndrome do not experience any symptoms, especially with the primary type. When symptoms do occur, they are usually related to increased pressure inside the skull or problems with hormone production by the pituitary gland. These symptoms are often mild and non-specific, making the condition hard to identify based on symptoms alone.

For many individuals with primary empty sella syndrome, the condition is asymptomatic, meaning it causes no noticeable symptoms. It is often discovered incidentally during a brain scan performed for an unrelated reason. When symptoms do appear, they are usually rare and can include headaches, which are the most common symptom, though often not directly caused by the empty sella itself. Some people may experience high blood pressure (hypertension) or, in very rare cases, a buildup of fluid in the brain (hydrocephalus). Less commonly, if the empty sella syndrome affects the pituitary gland's ability to produce hormones, symptoms of hormone deficiency might occur. These can include fatigue, low sex drive, or irregular menstrual periods in women. Vision problems are rare but can happen if the condition affects the optic nerves, which are located near the sella turcica.

Causes & risk factors

Empty sella syndrome can be classified as primary or secondary, depending on its cause. Primary empty sella syndrome occurs when the diaphragm sellae, a membrane covering the pituitary gland, has a small opening, allowing cerebrospinal fluid to enter the sella turcica. Secondary empty sella syndrome results from other medical conditions, treatments, or injuries that affect the pituitary gland.

Primary empty sella syndrome is believed to occur when the diaphragm sellae, a protective membrane that covers the pituitary gland, has a small opening. This opening allows cerebrospinal fluid, which normally surrounds the brain, to push into the sella turcica. Over time, this pressure can flatten the pituitary gland against the bone. This primary type is more commonly found in women, especially those who are overweight (obese) and have high blood pressure (hypertension). However, it can occur in anyone and is often discovered by chance without any clear risk factors. Secondary empty sella syndrome develops due to a specific event or condition that damages or removes the pituitary gland. Causes can include surgery on the pituitary gland, radiation therapy to the head, or a head injury (trauma). Other causes may involve tumors in the area, infections, or conditions like Sheehan's syndrome, which is damage to the pituitary gland from severe blood loss during childbirth. In these cases, the sella becomes "empty" because the gland has been damaged or removed.

How it's diagnosed

Empty sella syndrome is usually diagnosed incidentally when imaging tests of the brain, such as an MRI (magnetic resonance imaging) or CT (computed tomography) scan, are performed for other reasons. These scans can show the sella turcica filled with cerebrospinal fluid and a flattened pituitary gland. A doctor may also order blood tests to check hormone levels if symptoms suggest a pituitary problem.

The most common way empty sella syndrome is diagnosed is through brain imaging tests. A doctor might order an MRI (magnetic resonance imaging) or CT (computed tomography) scan to investigate headaches, vision problems, or other neurological symptoms. These scans provide detailed images of the brain and can clearly show the sella turcica filled with cerebrospinal fluid and a flattened pituitary gland. An MRI is often preferred because it offers more detailed images of soft tissues, making it easier to visualize the pituitary gland and the surrounding structures. The imaging results help confirm the presence of an empty sella. If you have symptoms that suggest a problem with hormone production, your doctor may also order blood tests. These tests measure the levels of various hormones produced by the pituitary gland, such as thyroid hormones, cortisol, growth hormone, and sex hormones. Vision tests may also be conducted if you report any changes in your sight. The diagnosis is made by combining imaging findings with a review of your medical history and any symptoms you may have.

Treatment options

Most people with primary empty sella syndrome do not need treatment because the condition rarely causes symptoms or health problems. If symptoms do occur, treatment focuses on managing those specific issues. For example, hormone replacement therapy may be prescribed if blood tests show low pituitary hormone levels, or medication might be given for headaches.

For the majority of individuals with primary empty sella syndrome, no specific treatment is necessary. Since the condition often causes no symptoms and does not typically lead to health complications, doctors usually recommend a "watch and wait" approach. If symptoms are present, treatment is directed at managing those specific issues. For instance, if you experience headaches, your doctor may recommend pain relievers or other headache management strategies. If blood tests reveal a deficiency in one or more pituitary hormones, hormone replacement therapy will be prescribed to restore normal hormone levels. This might involve taking thyroid hormone, cortisol, or sex hormones. In very rare cases, if the empty sella syndrome leads to a buildup of cerebrospinal fluid in the brain (hydrocephalus) that causes severe symptoms, surgery to place a shunt might be considered. For secondary empty sella syndrome, treatment focuses on addressing the underlying cause, such as managing a tumor or treating an infection. Regular follow-up appointments may be recommended to monitor your condition and ensure no new symptoms develop.

Recovery & outlook

The outlook for people with empty sella syndrome is generally excellent, especially for those with the primary type who have no symptoms. Most individuals live normal, healthy lives without any complications. If symptoms or hormone imbalances are present, they can often be effectively managed with appropriate treatment, leading to a good quality of life.

For most people diagnosed with primary empty sella syndrome, the prognosis is very good. The condition is often benign, meaning it is not harmful, and many individuals live their entire lives without experiencing any related health problems or needing treatment. It rarely progresses or causes serious complications. Even when symptoms or hormone deficiencies occur, they are typically manageable. Hormone replacement therapy can effectively correct imbalances, allowing individuals to maintain a good quality of life. Regular monitoring by a doctor helps ensure that any changes in symptoms or hormone levels are addressed promptly. The outlook for secondary empty sella syndrome depends on the underlying cause and how effectively that condition can be treated. Overall, empty sella syndrome itself is rarely life-threatening, and with proper management of any associated symptoms, most people can expect a positive long-term outcome.

When to see a doctor

You should see a doctor if you experience new or worsening symptoms that could be related to empty sella syndrome, such as persistent headaches, vision changes, or signs of hormone imbalance like extreme fatigue or unexplained weight changes. While empty sella syndrome is often harmless, these symptoms could indicate a need for evaluation or management of an underlying condition.

If you have been diagnosed with empty sella syndrome and develop new or worsening symptoms, it is important to consult your doctor. You should also seek medical attention if you experience any of the following, whether or not you have a known diagnosis of empty sella syndrome: * **Persistent or severe headaches:** Especially if they are different from your usual headaches or do not respond to typical pain relievers. * **Vision problems:** This includes blurred vision, double vision, or a loss of peripheral (side) vision. * **Symptoms of pituitary hormone deficiency:** These can be subtle but might include unexplained fatigue, significant weight changes, changes in your menstrual cycle (for women), low sex drive, or feeling cold more often than usual. Any sudden or severe neurological symptoms, such as a sudden, excruciating headache accompanied by nausea or vomiting, or sudden vision loss, should prompt immediate medical attention. While empty sella syndrome is usually benign, these symptoms could indicate other conditions that require urgent care.

Frequently asked questions

Can empty sella syndrome cause memory problems?

Empty sella syndrome itself is not typically known to cause memory problems. If memory issues occur, they are more likely related to other underlying health conditions or factors, rather than directly caused by the empty sella.

Is empty sella syndrome a serious condition?

For most people, especially those with primary empty sella syndrome, it is not a serious condition and often causes no symptoms. It is usually discovered by chance and does not lead to significant health problems.

Can empty sella syndrome go away on its own?

Empty sella syndrome is a structural change that typically does not go away on its own. However, since it often causes no symptoms, it may not require any treatment and can remain stable throughout a person's life.

Does empty sella syndrome affect fertility?

Empty sella syndrome can affect fertility if it leads to a significant deficiency in pituitary hormones that regulate reproductive function. If hormone levels are normal, fertility is usually unaffected. If hormone levels are low, treatment can often help.

Is empty sella syndrome hereditary?

Primary empty sella syndrome is generally not considered hereditary. Secondary empty sella syndrome is caused by other medical events or conditions and is also not inherited.

What is the difference between primary and secondary empty sella syndrome?

Primary empty sella syndrome occurs without a clear cause, often due to a natural opening in the membrane covering the pituitary gland. Secondary empty sella syndrome develops as a result of another condition, such as surgery, radiation, injury, or a tumor affecting the pituitary gland.

Sources

• MedlinePlus — Empty Sella Syndrome
• Mayo Clinic — Empty Sella Syndrome
• Cochrane Library — Empty Sella Syndrome