Empty Sella Syndrome: Symptoms, Causes and Treatment

Sella turcica is a bony cavity in the brain which encloses a pea sized pituitary gland. Empty sella syndrome (ESS) is a medical condition in which pituitary glands shrinks or become flattened. It is named so because at the first look it appears that the sella turcica is empty that is pituitary gland is missing. People with empty sella syndrome may or may not have symptoms. The symptoms are due to partial or complete loss of the function of the pituitary gland and includes headaches, impotency, and low sex drive. Empty sella syndrome can occur in up to 25% of the total individual in a population but most of them are asymptomatic as according to researchers less than 1% of the individuals having empty sella syndrome develop symptoms.

Causes of Empty Sella Syndrome

The pituitary gland is located in the sella turcica and attached to the brain by a thin stalk. When it shrinks or flattens, it cannot be seen on an MRI scan. This makes the region where pituitary gland is located as to look like an “empty sella”. It is lined by coverings of the brain and coverings contain cerebrospinal fluid (CSF). On the basis of different cause of the reduction in the size of pituitary there are two types of empty sella syndrome

Primary empty sella syndrome: it is believed that due to some anatomical defects in the coverings, CSF leaks out and gets accumulated partially or fully in the cavity of sella turcica. It compresses and flattens the pituitary gland. It affects women approximately 4 times more than men.

Secondary empty sella syndrome: it can occur due to various reasons which causes damage to the pituitary gland by

• Trauma due to injury to the head or surgery on the pituitary region
• Tumors
• Radiation therapy

• Infection

Symptoms of Empty Sella Syndrome

The most cases of empty sella syndrome especially primary empty sella syndrome are asymptomatic that is the person have no complaints. The symptoms more commonly occur in the secondary empty sella syndrome and these may vary from person to person and also includes disruption of the normal functioning of the pituitary as

• Chronic headaches
• Erection problems in males
• Decreased desire of sex
• Fatigue or low energy
• Abnormalities in the vision

Diagnosis of Empty Sella Syndrome

Your doctor will use your medical history, conduct a physical examination and order some imaging tests to establish a diagnosis

Medical history: your doctor will ask you questions about your symptoms in details and would try to identify the characteristics symptoms related with the disease such as decreased libido, headaches, general weakness. Most of the times the patient presents with no symptoms and it becomes difficult to suspect on the basis of medical history alone.

Physical examination: your doctor will examine your body from head to the toe and would try to look for some specific signs and symptoms. Most of the times there are no signs and symptoms found.

Laboratory test

• Imaging test: If your doctor suspects it on the basis of your medical history, he or she can order some imaging tests like CT scan or MRI to look for the sella turcica. Many of the times doctor found the defect during an imaging done for the other reasons. The imaging will also tell your doctor whether you have partial or complete empty sella turcica syndrome which depends upon the volume of cavity occupied by CSF.
• Fundoscopy: it can be done to look for the symptoms of increased intracranial pressure. Here your doctor looks the retina of the eyes.

Treatment of Empty Sella Syndrome

Empty sella syndrome with no symptoms doesn’t require treatment but if the symptoms are present then they are treated as

Medications: Analgesics can be prescribed by your doctor if you are having headaches and other medications can be given symptomatically.

Hormone replacement therapy: if there is pituitary dysfunction due to unbalance of hormone levels then the suitable hormone replacement therapy is given.

Surgery: it can be required in the cases when CSF is leaking or a tumor is the underlying cause.

If you have secondary empty sella syndrome due to other underlying causes then it will be dealt according to the symptoms.

Prognosis of Empty Sella Syndrome

The asymptomatic patients are normal and don’t require treatment. The symptomatic patients with treatment leads a normal life without decrease in life expectancy.

References

Empty sella syndrome. (n.d.).

Empty sella syndrome information page. (n.d.).

Empty-sella-syndrome

Kaiser U, Ho KKY. Pituitary physiology and diagnostic evaluation. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed.