Empty Sella Syndrome

ByJohn D. Carmichael, MD, Keck School of Medicine of the University of Southern California
Reviewed/Revised Apr 2023

    In empty sella syndrome, the sella turcica (the bony structure at the base of the brain that houses the pituitary gland) fills with cerebrospinal fluid, partially or completely compressing the gland and may enlarge the sella turcica.

    (See also Overview of the Pituitary Gland.)

    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 turcica. As a result, cerebrospinal fluid puts increased pressure on the pituitary gland and the walls of the sella turcica. The sella turcica may enlarge, and the pituitary gland may shrink, causing the sella to appear empty on imaging studies.

    Empty sella syndrome occurs most often in middle-aged women who are overweight and who have high blood pressure. Less commonly, the condition occurs after pituitary surgery, radiation therapy, or infarction (death) of a pituitary tumor.

    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 blood pressure as well. In rare cases, there is leaking of the cerebrospinal fluid from the nose or problems with vision.

    Empty sella syndrome can be diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI). Pituitary function is checked by measuring hormone levels in the blood to rule out hormone excess or deficiency. But pituitary function is usually normal.

    Treatment is rarely needed. It is given only if the pituitary produces too much or too little hormones, depending on which hormones are affected. Treatment may be replacing the deficient hormone or giving medications to decrease excess hormone production.

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