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Empty Sella Syndrome

What is empty sella syndrome?

Empty sella syndrome (ESS) may occur if you have an enlarged sella turcica. This is a bony structure where the pituitary gland sits at the base of the brain. During an imaging test of the area, the pituitary gland may first look like it is missing. 

There are 2 types of ESS: primary and secondary.

  • Primary ESS. The pituitary gland is usually flattened. This type is more common in women who are obese and have high blood pressure. It has also been linked to fluid buildup in the brain. 
  • Secondary ESS. The pituitary gland may be small because of a genetic change (mutation), injury, radiation therapy, or surgery.

What causes empty sella syndrome?

Health experts don’t know what causes primary ESS. Secondary ESS may be caused by injury, radiation therapy, or surgery. ESS is not a life-threatening illness.

What are the symptoms of empty sella syndrome?

You may not have any symptoms. If symptoms occur, they may include:

  • Impotence in men
  • Less desire for sex
  • Irregular menstrual periods in women

Symptoms vary from person to person. They also depend on your age and what caused the syndrome. Symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is empty sella syndrome diagnosed?

Your healthcare provider will ask about your medical history and do a physical exam. You may also need these tests:

  • CT scan. This test uses X-rays and a computer to make images of your body. It helps find any problems.
  • MRI. This test creates 2-D views of an internal organ or structures, especially the brain or spinal cord.

How is empty sella syndrome treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

You may not need treatment if you do not have any symptoms, and if your pituitary gland is not enlarged. Your healthcare provider will treat any hormone problems with hormone replacement.

When should I call my healthcare provider?

Call your healthcare provider if your symptoms get worse or you have new ones.

Key points

  • ESS may happen if you have an enlarged sella turcica. This is a bony structure where the pituitary gland sits at the base of the brain.
  • Health experts don’t know what causes primary ESS. Secondary ESS may be caused by injury, radiation therapy, or surgery.
  • It is not a life-threatening condition.
  • You may not have any symptoms. If symptoms occur, they may include impotence, less desire for sex, and irregular menstrual periods.  
  • You may not need treatment if you do not have symptoms, and if your pituitary gland is not enlarged.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Medical Reviewers:

  • Hurd, Robert, MD
  • Berry, Judith, PhD, APRN