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Empty sella syndrome

Definition

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

Causes

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. In Latin, it means Turkish saddle.

When the pituitary gland shrinks or becomes flattened, it cannot be seen on an MRI scan. This makes the pituitary gland look like an "empty sella." But the sella is not actually empty. It is often filled with cerebrospinal fluid (CSF). CSF is fluid that surrounds the brain and spinal cord. With empty sella syndrome, CSF has leaked into the sella turcica, putting pressure on the pituitary gland. This causes the gland to shrink or flatten.

Primary empty sella syndrome occurs when one of the layers (arachnoid) covering the outside of the brain bulges down into the sella and 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 young, obese women.

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

  • Adrenal glands
  • Ovaries
  • Testicles
  • Thyroid

A problem with the pituitary gland can lead to problems with any of the above glands and abnormal hormone levels of these glands.

Symptoms

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

If there are symptoms, they may include any of the following:

  • Erectile dysfunction (impotence)
  • Headaches
  • Irregular or absent menstruation
  • Low sexual desire (low libido)
  • Fatigue, low energy
  • Nipple discharge

Exams and Tests

Primary empty sella syndrome is most often discovered during an MRI or CT scan of the head and brain. 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)

Treatment

For primary empty sella syndrome:

  • There is no treatment if pituitary function is normal.
  • Medicines may be prescribed to treat any abnormal hormone levels.

For secondary empty sella syndrome, treatment involves replacing the hormones that are lacking.

In some cases, surgery is needed to repair the sella turcica.

Outlook (Prognosis)

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

Possible 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.

When to Contact a Medical Professional

Contact your health care provider if you develop symptoms of abnormal pituitary function, such as menstrual cycle problems 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: Elsevier Saunders; 2011:chap 8.


Review Date: 11/7/2013
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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