Makindo Medical Notes

Related Subjects: |Male Infertility |Prolactin |Prolactinoma |Sheehan's syndrome |Acromegaly and Giantism

💧 Empty Sella Syndrome occurs when the pituitary gland appears flattened or shrunken within the sella turcica. Often discovered incidentally on imaging 🖼️, most cases are asymptomatic with preserved pituitary function ✅. Thorough evaluation is important to exclude underlying endocrine dysfunction 🧬.

📖 About Empty Sella Syndrome

Empty Sella Syndrome is due to herniation of cerebrospinal fluid (CSF) into the sella turcica, making the pituitary gland look absent or thinned on MRI. It can be primary (idiopathic, often linked to raised intracranial pressure) or secondary (following surgery, infarction, haemorrhage, or Sheehan’s syndrome).

• 🪑 Enlarged sella filled with CSF → “empty” appearance.
• 👩‍🦱 Predominantly affects women (80%), often obese (70%) and hypertensive (30%).
• 🧬 Pituitary function normal in ~90% cases.

🧠 Anatomy

• The sella turcica 🪑 is a saddle-shaped depression in the sphenoid bone housing the pituitary gland.
• The sellar diaphragm (a thin membrane) covers the sella; defects here allow CSF herniation.

⚙️ Causes

• 👶 Primary: Defective/incomplete diaphragm, raised intracranial pressure, idiopathic intracranial hypertension.
• 🩸 Secondary: Infarction, pituitary apoplexy, Sheehan’s syndrome, neurosurgery, or radiotherapy.

🔎 Clinical Presentation

• Primary:
  • Middle-aged obese women 👩‍🦱.
  • Often asymptomatic ✅.
  • Chronic headaches 🤕.
  • Possible hyperprolactinemia (galactorrhoea, menstrual irregularity).
• Secondary:
  • Hypopituitarism → fatigue, amenorrhoea, infertility, adrenal/thyroid insufficiency 🧬.
  • Diabetes insipidus 💧 (polyuria, polydipsia).

🧪 Investigations

• 🩸 Bloods: Pituitary profile (cortisol, TFT, prolactin, sex hormones, GH).
• 🖼️ MRI (preferred): Shows CSF-filled sella with flattened pituitary.
• 🖥️ CT: Alternative if MRI contraindicated.
• 👀 Visual fields: If optic chiasm compression suspected.

🛠️ Management

• 💊 Hormone replacement: As required (hydrocortisone, levothyroxine, sex hormones, desmopressin).
• ✅ No treatment: Asymptomatic, normal pituitary function → reassurance + monitoring.
• 📅 Monitoring: Lifelong endocrine follow-up to detect late hormone deficiencies.
• ⚠️ Treat cause: e.g. manage IIH, treat Sheehan’s syndrome, reduce ICP.

📚 Case Example

👩 A 42-year-old obese woman with hypertension presents with chronic daily headaches 🤕. MRI brain (done for headaches) shows an enlarged sella turcica filled with CSF, with a thin rim of pituitary tissue. Blood tests: Pituitary hormones all within normal range. ✅ Diagnosis: Primary Empty Sella Syndrome. 🛠️ Management: Reassurance + annual endocrine follow-up.

🌟 Prognosis

• ✅ Primary: Excellent — usually incidental, stable, with preserved pituitary function.
• ⚠️ Secondary: Depends on cause; may need lifelong hormone replacement.