Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Empty sella syndrome (ESS) is a condition that involves thesella turcica, a bony structure at the base of the brain that surrounds and protects the pituitary gland. The pituitary gland is a round, pea-sized structure that lies at the base of the brain behind the nasal cavity.
When the sella turcica becomes partially or completely filled withcerebrospinal fluid, it causes the pituitary gland to become flattened against the bony wall of the sella turcica. Because most of the sella is now filled with fluid instead of tissue, on medical imaging studies it appears to be empty. This condition is called the “empty sella syndrome.”
It is not a life-threatening condition and there are no typical signs or symptoms of ESS. In most people, the diagnosis is made incidentally when a brain imaging study (MRI or CT scan) is done for another reason.
This article discusses the types of ESS, potential symptoms, causes, and treatment.
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Symptoms of Empty Sella Syndrome
Strictly speaking, empty sella syndrome is not a syndrome at all, since a syndrome is a set of medical signs or symptoms that tend to occur together. Empty sella syndrome, in contrast, is merely a description of what is seen on an imaging study, and there is no typical set of clinical signs or symptoms associated with this imaging finding.
Most people with empty sella have no symptoms at all, and the condition is discovered incidentally when they have a brain imaging study for some other purpose.
In men, elevated prolactin levels can cause:
Symptoms are much more common in people with secondary empty sella syndrome. The underlying condition that is causing the empty sella may itself produce symptoms. In addition, the loss of some or all pituitary function is often seen with secondary empty sella.
Pituitary Malfunction With Empty Sella
The pituitary gland is a “master gland,” in that it secretes hormones that regulate several other important hormone-producing glands throughout the body, including the:
With secondary ESS, the pituitary gland may not be able to secrete its regulatory hormones in the appropriate amounts.
Depending on which specific pituitary hormones are disrupted, a person with empty sella may experience symptoms related to:
What Causes Empty Sella Syndrome?
When empty sella syndrome is discovered through an imaging study, it will first be classified as either primary or secondary.
Primary Empty Sella Syndrome
Primary ESS means that no specific underlying cause is identifiable.
It is believed that in most cases, primary ESS occurs when a congenital defect in the tissue lining the brain creates the potential for cerebrospinal fluid to enter the sella turcica, flattening the pituitary gland and displacing it to one side.
In these cases the pituitary gland itself, while difficult to see on an imaging study, is almost always functioning normally. Consequently, most people with primary empty sella syndrome have no associated symptoms.
Primary ESS is most often diagnosed in middle-aged women who are overweight or obese and have hypertension. The reason why empty sella syndrome appears to be more common in these people is unknown.
Secondary Empty Sella Syndrome
There are several causes of secondary empty sella syndrome including:
People with secondary ESS often develop symptoms, either due to the underlying cause itself or due to subsequent disruption of pituitary gland function.
In most people with primary empty sella syndrome, the diagnosis is made incidentally when a brain imaging study (MRI or CT scan) is done for another reason. If there are no symptoms, your healthcare provider will usually do screening blood tests measuring thyroid hormones and cortisol levels. If these are normal, generally no further evaluation is needed.
For people with secondary empty sella syndrome, symptoms lead to a medical workup looking for hormonal abnormalities. Various blood tests generally find one or more hormone deficiencies and subsequent imaging studies lead to the diagnosis of ESS.
How Is Empty Sella Syndrome Treated?
The large majority of people with primary ESS have no symptoms and no hormonal abnormalities and do not need to be treated. In those uncommon cases in which primary ESS is causing symptoms due to elevated prolactin levels, treatment withbromocriptineusually decreases prolactin production to the point that symptoms are eliminated.
In people with secondary ESS, treatment usually consists of replacing the deficient hormones. However, depending on the underlying cause, surgical treatment may be needed.
Summary
Empty sella syndrome is usually diagnosed as an incidental finding on a brain imaging study that has been done for another reason. Most people have no symptoms and need no treatment.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Auer MK, Stieg MR, Crispin A, Sievers C, Stalla GK, Kopczak A.Primary empty sella syndrome and the prevalence of hormonal dysregulation.Dtsch Arztebl Int. 2018;115(7):99–105. doi:10.3238/arztebl.2018.0099Endocrine Society.Hyperprolactinemia.National Institute of Neurological Disorders and Stroke.Empty sella syndrome.National Organization for Rare Disorders.Empty sella syndrome.Johns Hopkins Medicine.Empty sella syndrome.Diri H, Tanriverdi F, Karaca Z, et al.Extensive investigation of 114 patients with Sheehan’s syndrome: a continuing disorder.Eur J Endocrinol.2014;171:311. doi:10.1530/EJE-14-0244Melmed S, Casanueva FF, Hoffman AR, et al.Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2011;96:273. doi:10.1210/jc.2010-1692
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Auer MK, Stieg MR, Crispin A, Sievers C, Stalla GK, Kopczak A.Primary empty sella syndrome and the prevalence of hormonal dysregulation.Dtsch Arztebl Int. 2018;115(7):99–105. doi:10.3238/arztebl.2018.0099Endocrine Society.Hyperprolactinemia.National Institute of Neurological Disorders and Stroke.Empty sella syndrome.National Organization for Rare Disorders.Empty sella syndrome.Johns Hopkins Medicine.Empty sella syndrome.Diri H, Tanriverdi F, Karaca Z, et al.Extensive investigation of 114 patients with Sheehan’s syndrome: a continuing disorder.Eur J Endocrinol.2014;171:311. doi:10.1530/EJE-14-0244Melmed S, Casanueva FF, Hoffman AR, et al.Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2011;96:273. doi:10.1210/jc.2010-1692
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Auer MK, Stieg MR, Crispin A, Sievers C, Stalla GK, Kopczak A.Primary empty sella syndrome and the prevalence of hormonal dysregulation.Dtsch Arztebl Int. 2018;115(7):99–105. doi:10.3238/arztebl.2018.0099Endocrine Society.Hyperprolactinemia.National Institute of Neurological Disorders and Stroke.Empty sella syndrome.National Organization for Rare Disorders.Empty sella syndrome.Johns Hopkins Medicine.Empty sella syndrome.Diri H, Tanriverdi F, Karaca Z, et al.Extensive investigation of 114 patients with Sheehan’s syndrome: a continuing disorder.Eur J Endocrinol.2014;171:311. doi:10.1530/EJE-14-0244Melmed S, Casanueva FF, Hoffman AR, et al.Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2011;96:273. doi:10.1210/jc.2010-1692
Auer MK, Stieg MR, Crispin A, Sievers C, Stalla GK, Kopczak A.Primary empty sella syndrome and the prevalence of hormonal dysregulation.Dtsch Arztebl Int. 2018;115(7):99–105. doi:10.3238/arztebl.2018.0099
Endocrine Society.Hyperprolactinemia.
National Institute of Neurological Disorders and Stroke.Empty sella syndrome.
National Organization for Rare Disorders.Empty sella syndrome.
Johns Hopkins Medicine.Empty sella syndrome.
Diri H, Tanriverdi F, Karaca Z, et al.Extensive investigation of 114 patients with Sheehan’s syndrome: a continuing disorder.Eur J Endocrinol.2014;171:311. doi:10.1530/EJE-14-0244
Melmed S, Casanueva FF, Hoffman AR, et al.Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2011;96:273. doi:10.1210/jc.2010-1692
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