Empty sella syndrome

Definition

Empty sella syndrome is a condition in which the bones (sella turcica) that surround part of the pituitary gland shrink or become flattened.

Causes

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

When the sella turcica surrounding the pituitary gland shrinks or becomes flattened, it can not be seen on CT or MRI scans. This is referred to as empty sella syndrome.

Primary empty sella syndrome occurs when a small defect above the pituitary gland increases pressure in area.

Secondary empty sella syndrome occurs when the sella is empty because the pituitary gland has shrunk following an injury, surgery, or radiation therapy.

Symptoms

Symptoms of primary empty sella syndrome include:

• Occasional symptoms resulting from high prolactin levels
• Irregular or absent menstruation
• Low libido (sexual desire)
• Impotence (erectile dysfunction)

Often, there are no symptoms or loss of pituitary function.

Patients with secondary empty sella syndrome may have symptoms caused by partial or complete loss of pituitary gland function. For more information, see the article on hypopituitarism.

Empty sella syndrome may be associated with abnormal pituitary function in children, most commonly low levels of growth hormone. However, levels of other pituitary hormones may also be low.

Exams and Tests

Primary empty sella syndrome is most often discovered during radiological imaging of the brain. Pituitary function is usually normal, and patients do not have any symptoms. The hormone prolactin is a little high in 10-15% of patients, and may interfere with normal function of the testicles or ovaries.

Tests of pituitary gland function may be done to make sure that the gland is working normally. See: Hypopituitarism

Treatment

For primary empty sella syndrome:

• There is no specific treatment if pituitary function is normal.
• Medications such as bromocriptine, which lower prolactin levels, may be prescribed if the prolactin levels are high and interfering with function of the ovaries or testes.

For secondary empty sella syndrome:

• Treatment involves replacing the hormones that are lacking.

Outlook (Prognosis)

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

Possible Complications

Complications of primary empty sella syndrome include mild hyperprolactinemia.

Complications of secondary empty sella syndrome are related to the underlying cause of pituitary gland disease or to the effects of too little pituitary hormone.

When to Contact a Medical Professional

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