Empty sella syndrome

Definition
Empty sella syndrome is the absence of the pituitary gland on radiological imaging of the sella turcica, a bony structure that normally partly surrounds the gland.

Causes, incidence, and risk factors

The pituitary gland is a small gland located at the base of the brain. It makes several hormones that control the function of other glands in the body, including the thyroid, the adrenal glands, and the ovaries or testes.

The pituitary gland is partly surrounded by a bony structure called the sella turcica (“Turkish saddle”). When the pituitary gland is not visible on CT or MRI scans of the sella turcica, the condition is referred to as empty sella syndrome. Primary empty sella syndrome occurs when a small anatomical defect above the pituitary gland increases pressure in the sella turcica and causes the gland to flatten out along the walls of the sella. When the sella is empty because the pituitary gland has regressed following an injury such as head trauma or an event such as surgery or radiation therapy, the condition is called secondary empty sella syndrome.

Primary empty sella syndrome is most often an incidental finding during radiological imaging of the brain. Pituitary function is usually normal, and patients do not have any symptoms. The hormone prolactin is mildly elevated in 10% to 15 % of patients, and the elevated prolactin may interfere with normal function of the testes or ovaries.

MEDICATIONS such as bromocriptine that suppress prolactin production are effective in correcting the problem.

Patients with an empty sella due syndrome to destruction of the pituitary gland have signs and symptoms caused by partial or complete loss of pituitary gland functions. The causes and symptoms of pituitary insufficiency are reviewed in the article on hypopituitarism.

Empty sella syndrome is often associated with abnormal pituitary function in children. Isolated deficiency of growth hormone (GH) is most common, but other pituitary hormones may also be deficient. One study observed empty sella in 48% of children with GH deficiency or multiple pituitary hormone deficiencies compared to only 2% of children with normal pituitary function.

Symptoms

Primary empty sella syndrome:

     
  • Occasional symptoms due to elevated prolactin levels  
  • Irregular or absent menstruation  
  • Low libido  
  • Impotence (erectile dysfunction)

Frequently there are no symptoms of loss of pituitary function.

Secondary empty sella syndrome: symptoms are due to loss of pituitary gland function. See the article on hypopituitarism for a complete review.

Signs and tests

Brain imaging studies may show the following:

     
  • Enlarged sella and absent pituitary gland on CT scan  
  • Enlarged sella and absent pituitary gland on MRI scan

Tests of pituitary gland function may be performed to make sure that the gland is working normally. This testing is reviewed in the article on hypopituitarism.

Treatment

Primary empty sella syndrome:

     
  • No specific treatment if pituitary function is normal  
  • Medication to lower prolactin levels if the prolactin level is high and interfering with function of the gonads.

Secondary empty sella syndrome:

Therapy is directed at replacing hormones that are deficient as a result of abnormal pituitary gland function. See the article on hypopituitarism for a complete review.

Expectations (prognosis)

Primary empty sella syndrome does not have adverse health consequences, and it does not alter life expectancy.

The specific cause of pituitary gland injury and the effects of hypopituitarism contribute to the outcome with secondary empty sella syndrome.

Complications

Complications of primary empty sella syndrome include mild hyperprolactinemia.

Complications of secondary empty sella syndrome are related to the cause of pituitary gland regression or to the effects of hypopituitarism.

Calling your health care provider

Contact your health care provider if you develop symptoms of abnormal pituitary function occur such as disrupted menstrual cycle or impotence.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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