Empty sella syndrome

Definition

The pituitary gland is partially surrounded by a bony structure called the sella turcica. Normally, it is visible during a CT scan or MRI. In empty sella syndrome, the pituitary gland is not visible -- either because it has become flattened or has shrunk.

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 defect above the pituitary gland increases pressure in the sella turcica and causes the gland to flatten out along the walls of the sella. Secondary empty sella syndrome occurs when the sella is empty because the pituitary gland has shrunk following an injury, surgery, or radiation therapy.

Primary empty sella syndrome is most often found 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 10-15% 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 may be associated with abnormal pituitary function in children. Low levels of growth hormone (GH) is most common, but other pituitary hormones may also be deficient.

Symptoms

Primary empty sella syndrome:

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

Often, there are no symptoms or 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:

• There is 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 ovaries or testes.

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.

Illustrations

The pituitary gland

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empty sella syndrome