empty sella syndrome

Etiology

• may be normal variant
• may occur in association with other pituitary disorders
  • pituitary microadenomas
• may be associated with
  • previous pituitary surgery
  • pituitary radiation
  • pituitary apoplexy
  • Sheehan's syndrome
  • lymphocytic hypophysitis
  • idiopathic hypopituitarism

Epidemiology

• commonly seen in obese women evaluated for headache

Pathology

• sella turcica enlarged & not entirely filled with pituitary tissue
• herniation of CSF from the suprasellar cisterns into the sella causing pituitary compression & generally sella turcica enlargement

Clinical manifestations

• intracranial pressure may be increased
• visual changes
• hypopituitarism is rare
• headache

Laboratory

• laboratory assessment for pituitary deficiency
  • serum IGF-1
  • serum cortisol (AM)

may be optional

• ADH (serum sodium, serum osmolality, urine sodium, urine osmolality)
• serum TSH with reflex free T4
• serum LH serum FSH, 8 AM serum testosterone (male) serum estradiol (female)

Radiology

• lateral skull film may show ballooned or cup-shaped sella turcica
• myelographic dye may remain in sella of patients who have had prior myelograms
• CT or MRI* shows:
  • sella filled with CSF
  • pituitary stalk is midline & extends down to the compressed pituitary on the floor of the sella

* empty sella is a radiologic finding, not a distinct clinical entity

Differential diagnosis

• pituitary tumor

More general terms

• pituitary disease
• syndrome

Additional terms

• hypopituitarism
• lymphocytic (autoimmune) hypophysitis
• pituitary apoplexy
• sella turcica (hypophyseal fossa)
• Sheehan's syndrome

Patient information

empty sella syndrome patient information