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Empty sella syndrome

Definition

Empty sella syndrome is a condition in which the pituitary gland shrinks or becomes flattened.

Causes, incidence, and risk factors

The pituitary gland is a small gland located at the base of the brain. It sits in a saddle-like compartment in the skull called the "sella turcica," which in Latin means "Turkish saddle."

When the pituitary gland shrinks or becomes flattened, it cannot be seen on MRI scans, making it look like an "empty sella." This is called empty sella syndrome.

The pituitary makes several hormones that control the other glands in the body, including the:

  • Adrenal glands
  • Ovaries
  • Testicles
  • Thyroid

Primary empty sella syndrome occurs when a hole in the membrane covering the pituitary gland allows fluid in, which presses on the pituitary.

Secondary empty sella syndrome occurs when the sella is empty because the pituitary gland has been damaged by:

  • A tumor
  • Radiation therapy
  • Surgery

Empty sella syndrome may be seen in a condition called pseudotumor cerebri, which mainly affects obese women.

Symptoms

Often, there are no symptoms or loss of pituitary function.

Patients with empty sella syndrome may have symptoms caused by a partial or complete loss of pituitary gland function. For more information, see hypopituitarism.

Symptoms include:

Signs and tests

Primary empty sella syndrome is most often discovered during an MRI or CT scan. Pituitary function is usually normal.

The health care provider may test the pituitary to make sure that the gland is working normally.

Sometimes tests for high pressure in the brain will be done, such as:

  • Examination of the retina by an ophthalmologist
  • Lumbar puncture (spinal tap)

The hormone prolactin is a little high in a small percentage of patients. This may interfere with the normal function of the testicles or ovaries.

Treatment

For primary empty sella syndrome:

  • There is no treatment if pituitary function is normal.
  • Medications such as bromocriptine, which lower prolactin levels, may be prescribed if prolactin levels are high and interfering with the function of the ovaries or testes.

For secondary empty sella syndrome:

  • Treatment involves replacing the hormones that are lacking.

Expectations (prognosis)

Primary empty sella syndrome does not cause health problems, and it does not affect life expectancy.

Complications

Complications of primary empty sella syndrome include mild hyperprolactinemia.

Complications of secondary empty sella syndrome are related to the cause of pituitary gland disease or to the effects of too little pituitary hormone.

Calling your health care provider

Contact your health care provider if you develop symptoms of abnormal pituitary function, such as a disrupted menstrual cycle or impotence.

References

Melmed S, Kleinberg D, Ho Ken. Pituitary physiology and diagnostic evaluation. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 8.


Review Date: 12/11/2011
Reviewed By: Ari S. Eckman, MD, Division of Endocrinology and Nancy J. Rennert, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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