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Empty Sella Syndrome (Comprehensive)

A condition where the sella turcica is filled with cerebrospinal fluid, partially or completely flattening the pituitary gland.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Empty Sella Syndrome (Comprehensive)?

Empty sella syndrome (ESS) is a radiologic and clinical condition where the subarachnoid space herniates into the sella turcica through the diaphragma sellae and the pituitary gland is flattened against the sellar floor by CSF pressure. It is divided into two main types: primary (PES, idiopathic, due to congenital diaphragma sellae deficiency) and secondary (SES, after pituitary surgery, radiotherapy, tumor infarction).

Primary empty sella affects 1-12% of the population and is more common in middle-aged obese hypertensive women. Secondary empty sella develops after pituitary infarction (Sheehan syndrome, apoplexy), surgery, radiotherapy, or tumor regression. Pituitary function is usually preserved in PES but may be impaired in SES.

Most patients (70-80%) are asymptomatic and the diagnosis is made incidentally on cranial MRI. Symptomatic patients may have headache, visual disturbances (chiasm prolapse), CSF rhinorrhea, hyperprolactinemia (pituitary stalk effect), and varying degrees of hypopituitarism. Idiopathic intracranial hypertension may coexist (5-10%).

Symptoms

Asymptomatic in most cases (incidental finding)
Chronic headache (especially frontal and morning)
Visual disturbances: blurred vision, visual field defect, diplopia
Hyperprolactinemia findings: galactorrhea, amenorrhea, infertility
Hypopituitarism findings: fatigue, hypothyroidism, adrenal insufficiency
CSF rhinorrhea (clear fluid drip from nose)
Decreased libido
Growth retardation (children)
Idiopathic intracranial hypertension findings: papilledema

Risk Factors

Female sex (4:1 ratio)
Middle age (40-60 years)
Obesity (BMI >30)
Hypertension
Multiple pregnancy and births
Idiopathic intracranial hypertension
Pituitary surgery and radiotherapy history
Sheehan syndrome
Pituitary apoplexy
Congenital diaphragma sellae deficiency

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent unexplained headache
  • Visual disturbances and visual field defect
  • Galactorrhea, menstrual irregularity
  • Growth retardation in children
  • Clear fluid drip from nose (CSF leak)
  • Severe fatigue, weight changes (hormone deficiency)
  • Decreased libido and sexual dysfunction

Treatment Methods

01
Pituitary MRI with contrast (gold standard)
02
Pituitary hormone panel: prolactin, TSH/T4, ACTH/cortisol, FSH/LH/estradiol/testosterone, IGF-1
03
Visual field examination (chiasm involvement evaluation)
04
Asymptomatic primary ESS: only follow-up
05
Hyperprolactinemia: dopamine agonist (cabergoline)
06
Hypopituitarism: appropriate hormone replacement
07
CSF rhinorrhea: surgical repair (transsphenoidal)
08
Severe symptomatic ESS with chiasm prolapse: chiasmapexy
09
Idiopathic intracranial hypertension: weight loss, acetazolamide
10
Annual hormone panel and visual field follow-up

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.