What is empty sella syndrome?

Empty sella syndrome (ESS) is a rare disorder that affects a structure in the skull called the sella turcica. This is a bony structure at the base of the brain. It is where the pituitary gland is located. ESS may be seen on a brain or pituitary MRI. It is a description of what is found on the scan. Imaging tests show that the area looks larger than normal. And it is not completely filled by the pituitary gland.

There are 2 types of ESS, primary and secondary:

• Primary ESS. The pituitary gland is usually flattened. This type is more common in women who are obese and have high blood pressure. It has also been linked to cerebrospinal fluid buildup and pressure enlarging the sella turcica in the brain.

• Secondary ESS. This is used to describe ESS that is caused by an identifiable problem or disease of the pituitary gland. It may be from a small pituitary gland because of a genetic change (mutation), injury, radiation therapy, inflammation (hypophysitis), or surgery. Removing a pituitary tumor through surgery may leave behind an area filled only with spinal fluid.

What causes empty sella syndrome?

Experts don’t know what causes primary ESS. Secondary ESS may be caused by injury, tumor, radiation therapy, or surgery. ESS is not a life-threatening illness. Only about 1 in 4 people known to have empty sella syndrome have a primary hormone disturbance.

What are the symptoms of empty sella syndrome?

You may not have any symptoms. If symptoms occur, they may include:

• Headaches

• Erectile dysfunction

• Less desire for sex

• Irregular menstrual periods

• Early puberty in children in some cases

Symptoms vary from person to person. They also depend on your age and what caused the syndrome. Symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is empty sella syndrome diagnosed?

Your healthcare provider will ask about your health history and do a physical exam. You may also need these tests:

• CT scan. This test uses X-rays and a computer to make images of your body. It helps find any problems.

• MRI of the pituitary. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures in your body.

How is empty sella syndrome treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

You may not need treatment if you do not have any symptoms, and if your pituitary gland is not enlarged (partial empty sella syndrome). Your healthcare provider will treat any hormone problems with hormone replacement.

When should I call my healthcare provider?

Call your healthcare provider if your symptoms get worse or you have new ones.

Key points about empty sella syndrome

• Empty sella syndrome (ESS) affects a bony structure in the skull called the sella turcica. This is where the pituitary gland is located. With ESS, imaging tests show the area looks larger than normal. And it is not completely filled by the pituitary gland.

• Experts don’t know what causes primary ESS. Secondary ESS may be caused by injury, radiation therapy, or surgery.

• It is not a life-threatening condition.

• You may not have any symptoms. If symptoms occur, they may include headaches, male impotence, less desire for sex, and irregular menstrual periods.

• You may not need treatment if you don't have symptoms, and if your pituitary gland is not enlarged.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.