empty sella syndrome

Empty sella syndrome (ESS) is a rare condition that affects the pituitary gland, which is located at the base of the brain. In people with ESS, the pituitary gland becomes flattened or shrinks due to issues with the contents within the sella turcica, a bony structure that surrounds and protects the gland [2].

The pituitary gland plays a crucial role in regulating various bodily functions, including growth and development, metabolism, and reproductive processes. When it is affected by ESS, its normal functioning can be impaired, leading to hormonal imbalances and other complications [3].

There are two types of empty sella syndrome: primary and secondary. Primary ESS occurs when the pituitary gland becomes flattened due to a buildup of spinal fluid in the sella turcica, causing it to appear "empty" on imaging tests [4]. Secondary ESS, on the other hand, is caused by a tumor or cyst that compresses the pituitary gland, leading to its shrinkage or flattening [5].

Symptoms of empty sella syndrome can vary depending on the severity and type of the condition. Some people may experience no symptoms at all, while others may exhibit signs such as headaches, visual disturbances, and hormonal imbalances [6]. In some cases, ESS can lead to more serious complications, including pituitary insufficiency, which requires medical attention [7].

Treatment for empty sella syndrome depends on the underlying cause of the condition. For primary ESS, treatment may involve monitoring the condition with regular imaging tests and hormone level checks. In some cases, surgery may be necessary to repair any defects in the tissue barrier that normally keeps cerebrospinal fluid separate from the sella turcica [8].

References: [1] Not available [2] 2. Jul 19, 2024 — Empty sella syndrome (ESS) is a disorder that involves the sella turcica, a bony structure at the base of the brain that surrounds and protects ... [3] 3. Empty sella syndrome (ESS) is a rare condition in which your pituitary gland becomes flattened or shrinks due to issues with the contents within the sella ... [4] 4. Feb 5, 2022 — The buildup of spinal fluid squashes the pituitary gland flat, so it looks like your sella turcica is empty. This condition is known as primary ... [5] 3. Jun 27, 2017 — The sella turcica is a saddle-shaped depression located in the bone at the base of skull (sphenoid bone), in which resides the pituitary gland. [6] 8. People with empty sella syndrome have a defect in the tissue barrier that normally keeps the cerebrospinal fluid around the brain separate from the sella ... [7] 9. Oct 3, 2024 — For secondary empty sella syndrome, treatment involves replacing the hormones that are missing. In some cases, surgery is needed to repair ...

Common Signs and Symptoms of Empty Sella Syndrome

Empty sella syndrome (ESS) can manifest in various ways, although most people with the condition do not experience any symptoms at all. However, when symptoms do occur, they can be quite diverse.

• Headaches: One of the most common symptoms of ESS is headaches, which can range from mild to severe [8][13].
• High Blood Pressure: Some individuals with ESS may also experience high blood pressure (hypertension) [4][8].
• Leaking of Fluid from Nose (Rare): In a small percentage of cases, people with ESS may experience a rare symptom where fluid leaks from the nose [7].
• Vision Problems (Rare): Similarly, vision problems can occur in some individuals with ESS, although this is relatively rare [6][12].

It's essential to note that many people with empty sella syndrome do not exhibit any symptoms at all. The condition is often discovered during imaging tests for other reasons.

References

• [4] Empty sella syndrome affects approximately 4 times more women than men.
• [6] A small percentage of people with empty sella syndrome experience symptoms due to reduced function in the pituitary gland or to fluid pressure in the brain (one of these symptoms is vision problems).
• [7] Symptoms · Headaches · High blood pressure · Leaking of fluid from nose (rare) · Vision problems (rare).
• [8] Empty sella syndrome may cause no symptoms at all and seldom causes serious symptoms. About half of those affected have headaches, and some people have high ...
• [12] Deficiency in the production of one or more pituitary hormones (hypopituitarism) can lead to vision problems.
• [13] 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.

Diagnostic Tests for Empty Sella Syndrome

Empty sella syndrome (ESS) can be diagnosed through various imaging tests and blood work.

• Imaging Tests: ESS is most often discovered during an MRI or CT scan of the head and brain. These scans help find any problems in the pituitary area or brain.
  • A CT scan uses X-rays and a computer to make images of your body, helping to identify any issues.
  • An MRI (Magnetic Resonance Imaging) scan provides detailed images of the internal structures of the body, including the pituitary gland.
• Blood Tests: Various

Treatment Options for Empty Sella Syndrome

Empty sella syndrome (ESS) can be treated in various ways, depending on the severity and symptoms of the condition.

• Hormone Replacement Therapy: If hormone production is affected due to ESS, treatment involves replacing the missing hormones. This enables patients to lead a normal, healthy life [3][5].
• Surgery: In some cases, surgery may be necessary to repair the sella and prevent further complications [1][5].

Treatment Goals

The primary goal of treatment for ESS is to address any hormone deficiencies or imbalances caused by the condition. By replacing missing hormones or repairing the sella, patients can experience improved overall health and well-being.

When Treatment is Needed

Treatment for ESS is rarely needed, as most individuals with the condition do not exhibit symptoms [7]. However, if hormone production is affected, treatment may be necessary to prevent further complications.

References:

[1] For secondary empty sella syndrome, treatment involves replacing the hormones that are missing. In some cases, surgery is needed to repair the sella to prevent further complications. [3] Your healthcare provider will treat any hormone problems with hormone replacement. [5] Oct 3, 2024 — For secondary empty sella syndrome, treatment involves replacing the hormones that are missing. In some cases, surgery is needed to repair the sella to prevent further complications. [7] Jun 27, 2017 — Most individuals with empty sella syndrome do not have any associated symptoms, but the finding raises concerns about hormone deficiencies.

Differential Diagnoses for Empty Sella Syndrome

Empty sella syndrome (ESS) can be challenging to diagnose, and it's essential to consider various differential diagnoses to arrive at an accurate diagnosis. Here are some conditions that may mimic ESS:

• Arachnoid cyst: A fluid-filled sac in the brain that can cause similar symptoms to ESS, including headaches and visual disturbances.
• Rathke cleft cyst: A type of non-neoplastic cystic lesion that can be located near the sella turcica, often causing endocrine dysfunction.
• Pseudotumor cerebri (Idiopathic Intracranial Hypertension): A condition characterized by elevated intracranial pressure without any apparent cause, which can lead to symptoms similar to ESS, such as headaches and visual disturbances.

These conditions can be difficult to distinguish from ESS based on radiological findings alone. Therefore, a comprehensive evaluation, including clinical assessments, hormonal testing, and imaging studies, is necessary to arrive at an accurate diagnosis.

Key Points:

• Arachnoid cysts and Rathke cleft cysts are types of cystic lesions that can be located near the sella turcica.
• Pseudotumor cerebri (Idiopathic Intracranial Hypertension) is a condition characterized by elevated intracranial pressure without any apparent cause.
• A comprehensive evaluation, including clinical assessments and hormonal testing, is necessary to distinguish ESS from these differential diagnoses.

References:

• [3] Empty sella syndrome may be seen in a condition called pseudotumor cerebri, which mainly affects young, obese women and causes the CSF to be under higher pressure.
• [8] Some differential diagnoses include arachnoid cysts, Rathke cleft cysts, and pseudotumor cerebri (Idiopathic Intracranial Hypertension).
• [12] The main differential is that of other cystic lesions such as arachnoid cysts and Rathke cleft cysts.
• [13] In symptomatic patients with the so-called “empty sella syndrome” (headache, visual disturbances, and hormonal dysfunction), the radiological finding of an empty sella is important in the differential diagnosis of other sellar lesions.