Empty Sella Syndrome: Symptoms, Causes & Treatment

Empty sella syndrome is a condition in which the space in the skull that holds the pituitary gland, called the sella turcica, appears partially or completely filled with cerebrospinal fluid. This can sometimes place pressure on the pituitary gland.

In many cases, an empty sella does not cause any symptoms and is found by chance during routine imaging tests. When hormonal changes, headaches, or vision problems develop, it is known as empty sella syndrome.

If hormone levels are affected, an endocrinologist may recommend hormone replacement therapy. In rare cases, surgery may be needed if the fluid causes significant pressure on the pituitary gland or leads to vision problems.

Main symptoms

The most common symptoms of empty sella include:

• Frequent or ongoing headaches;

• Changes in vision;

• Fatigue or low energy;

• Hormonal changes that may affect growth, metabolism, or sexual function.

In some people, the pituitary gland continues to function normally and no symptoms occur. This can happen because the gland may be displaced from its usual position but still maintain its structure and ability to produce hormones.

The cerebrospinal fluid that fills the sella turcica can push the pituitary gland out of its normal position within the cavity. Even so, this displacement does not always interfere with hormone production.

Empty sella vs empty sella syndrome

Empty sella syndrome is diagnosed when the finding of a sella turcica filled with fluid is associated with symptoms or hormonal changes.

Partially empty sella

A partially empty sella occurs when only part of the cavity that contains the pituitary gland is filled with cerebrospinal fluid, while the remaining portion of the gland is still visible on imaging.

Most of the time, this does not cause symptoms. In some cases, mild hormonal changes or mild symptoms related to pressure on the pituitary gland may occur.

Confirming a diagnosis

The diagnosis is usually made by an endocrinologist or neurologist based on symptoms and imaging results. However, in many cases, an empty sella is discovered incidentally during imaging tests performed for other reasons.

According to the American College of Radiology (ACR), magnetic resonance imaging (MRI) is the preferred imaging method for evaluating the pituitary gland and surrounding structures, as it provides detailed visualization of the sella turcica and soft tissues.

Blood tests are also recommended to measure hormone levels, including cortisol, thyroid-stimulating hormone (TSH), sex hormones, and prolactin. These tests help determine whether the pituitary gland is functioning properly, even if the sella appears partially or completely filled with fluid.

Main causes

The main causes of empty sella include:

• Changes in the diaphragm of the sella turcica, which is the membrane that covers the cavity where the pituitary gland is located and may occur without a clear cause;

• Radiation therapy to the pituitary region;

• Pituitary apoplexy, which occurs when the pituitary gland experiences bleeding or reduced blood supply, leading to swelling or displacement within the sella turcica;

• Head injuries, such as severe trauma, falls, or accidents that affect the sella turcica;

• Tumors or surgical removal of tumors, which can leave extra space in the cavity after the procedure.

In these situations, cerebrospinal fluid may fill the sella turcica and press on or displace the pituitary gland.

Treatment options

Treatment for empty sella depends on whether symptoms are present and how severe they are. Options may include:

1. Hormone replacement therapy

Based on guidance from the Endocrine Society, hormone replacement therapy is recommended when laboratory tests confirm pituitary hormone deficiencies, with treatment individualized according to the specific hormone affected.

This may include replacement of cortisol, thyroid hormones, sex hormones, or growth hormone to help control symptoms and maintain hormonal balance.

2. Surgery

In rare cases, surgery may be recommended if there is significant pressure on the pituitary gland, vision changes, or leakage of cerebrospinal fluid.

Endoscopic reconstruction of the sella turcica is usually performed by a neurosurgeon. The goal is to relieve pressure or repair the area to protect pituitary function and improve symptoms.

Is it serious?

In most cases, empty sella is not considered serious. Many people do not have symptoms, and the pituitary gland continues to work normally.

Even so, regular monitoring of pituitary function is important to detect any hormonal changes or new symptoms over time.