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What Exactly Is An Empty Sella?

Maybe this sounds familiar: you’ve just had an MRI imageand as your physician discusses the results, she mentions that you have an empty sella. If this has happened to you, you’re not alone. In fact, approximately 70% of individuals with chronic IH develop empty sellas... Normally, the relatively round pituitary gland is visible within the sella turcica on imaging studies such as MRIs, CT scans and skull X-rays. But chronically high cerebrospinal fluid pressure can push through the membrane that covers the roof of the sella, which then causes the pituitary gland to flatten like a pancake against the walls of the sella and gives the appearance that the sella is empty. Occasionally, this can lead…

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Articles of Interest

Path to diagnosis (Part I: An empty sella)

An empty sella is when the sella, a bony space which holds the pituitary gland, appears “empty” (dark/black) on an MRI. This is because the space has been filled with cerebrospinal fluid, flattening the pituitary gland. Most radiologists and neurologists will consider this an “incidental finding,” meaning they believe it’s irrelevant to your symptoms. In my case, as so often happens, the radiologist didn’t even include it in the report. (This is why it is important to always request your original imaging discs, not just the report.)

A Comprehensive Review of Empty Sella and Empty Sella Syndrome

It has been historically thought that empty sella anatomy is an incidental finding without clinical significance that does not require further monitoring or treatment. For many patients this remains true, however, a portion will be diagnosed with empty sella syndrome (ESS), which is defined as a radiographic appearance of an empty sella in addition to endocrine or neurologic consequences. Symptoms in this clinical condition can include headache or vision loss associated with idiopathic intracranial hypertension (IIH), CSF rhinorrhea, or features of central hypothyroidism, secondary adrenal insufficiency, hypogonadotropic hypogonadism, or growth hormone deficiency. These or other symptoms are reported in up to 42% of patients with an empty sella.

Resources

Pituitary Network Association

Empty sella is often an incidental imaging finding without associated symptoms. If there are symptoms, patients with empty sella syndrome can have headaches as symptoms of elevated spinal fluid pressure; symptoms of hypopituitarism; or visual symptoms, which can sometimes be due to downward, prolapse of the optic chiasm into the empty sella.

The Pituitary Foundation

Empty Sella Syndrome is a condition where the bony cup the pituitary gland sits in (the sella turcica) appears empty when scanned. The pituitary gland may appear flattened or shrunken. Many people have no symptoms, whilst others require hormone replacement therapy.

NINDS

Normally, the pituitary gland fills a spot called the sella turcica (‘Turkish saddle’ in Latin). Modern medical imaging shows the gland filling the sella completely. Empty sella syndrome (or ESS) is diagnosed when the sella appears empty on imaging. Instead of showing the pituitary gland, the sella appears to be filled with cerebrospinal fluid (or CSF).

Radiopedia

Although many patients with so-called primary empty sella are entirely asymptomatic and endocrinologically normal, increasingly recognized are variable hypopituitarism (e.g. growth hormone deficiency 8) and hyperprolactinemia Whether these conditions are secondary to the empty sella or, rather, both the empty sella and endocrinopathy represent the sequelae of previous disease, is unclear.

StatPearls

Due to advances in radiologic technology, the incidence of empty sella has recently increased. Although empty sella has historically been considered an incidental finding without clinical significance, recent evidence suggests that patients may have associated symptoms, otherwise known as ESS, more frequently than previously believed.

You and Your Hormones

Empty sella syndrome is the term used to describe the appearance of a small, shrunken or absent pituitary gland on pituitary imaging. Most patients have no symptoms, and generally no treatment is required. If hormone deficiencies are present, hormone replacement therapy should be considered.