What is Empty Sella Syndrome?

The sella turcica is a small depression in the sphenoid bone at the base of the skull. The pituitary gland is located atop this depression, with the sella turcica providing support and protection for the gland. In empty sella syndrome, or ESS, the pituitary gland has flattened or shrunk, which makes the sella turcica appear to be empty. Empty sella syndrome occurs for a variety of reasons, including as a result of pituitary tumors or traumatic injury.

Empty sella syndrome is classified into two different types: primary and secondary. In Primary ESS, the cause of the syndrome typically is an anatomical defect that causes the pituitary gland to flatten over the surface of the sella turcica. One such defect is the result of a hole in the pituitary membrane. The hole allows excess fluid in the pituitary space, putting pressure on the gland and causing it to flatten. For women, pregnancy can be another cause. The pituitary gland can become enlarged during pregnancy, but after the woman gives birth, it can shrink to less than its normal size. In addition, the pituitary gland can shrink after menopause.

People with primary ESS typically are asymptomatic. Often, someone with the syndrome is not diagnosed unless he or she undergoes a medical imaging test for an unrelated reason. People with the primary syndrome sometimes have hypertension or headaches, but these symptoms are not caused by the syndrome. Other possible symptoms include low libido, irregular menstruation in women and erectile dysfunction in men. People with this type of empty sella syndrome generally do not need treatment for the syndrome itself but might need treatment for associated conditions such as high blood pressure or sexual dysfunction.

In secondary ESS, the syndrome is the result of damage that causes the pituitary gland to shrink. Surgery, traumatic head injury or radiation therapy can cause damage to the pituitary gland that might lead to ESS. Alternatively, the syndrome can result from the growth of a tumor that encroaches on the space occupied by the pituitary gland.

Hormones produced by the pituitary gland affect the sex organs, thyroid and adrenal glands, so secondary ESS might be associated with defects in these organs. Secondary empty sella syndrome symptoms vary depending on the sex of the individual with the condition, because of the involvement of the sex organs. Possible symptoms include infertility, low libido or sexual dysfunction, irregular or absent menstruation, reduced tolerance to infection and a lower stress threshold. Treatment of the symptoms of secondary ESS involves synthetic hormone treatment to replace the hormones that are lacking.