Is your pituitary gland "empty"? Let's learn about Empty Sella Syndrome!

Have you ever had a bad headache that just will not go away? Or maybe your doctor ordered a brain scan like a CT or an MRI to check things out.

If your doctor tells you that your pituitary gland area looks "empty" on the scan, you might feel worried. Doctors call this finding an empty sella, but it does not always mean you have a serious medical problem.

Let us look closely at what this condition means for your health, what symptoms might happen, and how doctors manage it.

What is Empty Sella Syndrome?

Empty Sella Syndrome, or ESS for short, is a rare health condition. In this condition, your pituitary gland becomes flat or compressed inside its protective bone pocket.

Your pituitary gland is a tiny, pea-sized organ sitting right at the base of your brain. It rests inside a bony structure called the sella turcica, which means "Turkish saddle" in Latin.

Think of the sella turcica as a tiny, safe house for your pituitary gland. Sometimes, extra fluid presses into this house, flattening the gland inside.

This gland is a vital part of your endocrine system. It makes important chemical messengers called hormones that control many other glands in your body.

Difference Between Empty Sella and Empty Sella Syndrome.

It is easy to mix up these two terms, so let us clear up the difference right away. An empty sella is just a picture on a scan, while Empty Sella Syndrome is an actual medical condition.

An empty sella means your scan shows a flat or small pituitary gland. The sella turcica looks empty to the radiologist reading the picture.

In reality, the space is usually filled with cerebrospinal fluid (CSF). This clear fluid surrounds and cushions your brain and spinal cord.

When CSF leaks into the sella turcica, it presses against your pituitary gland. This constant pressure makes the gland look flat on an imaging scan.

Doctors usually discover an empty sella completely by accident when looking at a head scan done for another reason.

Many people have an empty sella on a scan, feel completely fine, and have a normally working gland. You only have Empty Sella Syndrome (ESS) if the flattened gland causes real symptoms like hormone problems or headaches.

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Two Types of Empty Sella.

When a scan shows an empty sella, doctors divide the finding into two distinct types: primary and secondary.

• Primary Empty Sella: Doctors cannot find a clear underlying medical cause for the flattened pituitary gland. This type rarely leads to full Empty Sella Syndrome.
• Secondary Empty Sella: This type happens because of a known medical issue, previous surgery, or injury affecting the pituitary area. Secondary types are much more likely to cause ESS symptoms.

Is Empty Sella Syndrome Dangerous?

No, Empty Sella Syndrome is not a life-threatening illness. Doctors can manage hormone imbalances easily with daily medicine when needed.

Finding an empty sella on your brain scan is also not dangerous by itself. Most cases cause zero symptoms and never turn into a syndrome.

Role of the Pituitary Gland.

Your pituitary gland acts as the master control center for your body's hormone network. It tells other glands when to release their own hormones to keep you healthy.

The pituitary gland controls these major glands and systems:

• Adrenal glands near your kidneys.
• Ovaries in women and testicles in men.
• Thyroid gland in your neck.

Hormones act like chemical messengers traveling through your blood. They tell your tissues, organs, and muscles how to function every single day.

Your pituitary gland connects to the hypothalamus in your brain through a tiny stalk. The hypothalamus regulates your body temperature, blood pressure, hunger, and sleep cycles.

The pituitary gland makes several vital hormones, including:

• Adrenocorticotropic hormone (ACTH): Stimulates your adrenal glands to release stress hormones like cortisol.
• Antidiuretic hormone (ADH): Manages your body's water balance and hydration levels.
• Follicle-stimulating hormone (FSH): Supports egg maturation in women and sperm production in men.
• Growth hormone (GH): Drives normal childhood growth and helps maintain bone and muscle strength.
• Luteinizing hormone (LH): Works with FSH to control your reproductive system and sex hormones.
• Oxytocin: Helps with childbirth contractions and milk release during breastfeeding.
• Prolactin: Stimulates breast milk production after childbirth.
• Thyroid-stimulating hormone (TSH): Directs your thyroid gland to make energy-regulating hormones.

These hormones do not flow constantly. Your body releases them in natural bursts every few hours.

Who is Most Affected by Empty Sella Syndrome?

While ESS is rare, it can affect both children and adults. However, primary empty sella affects women about four times more often than men.

Doctors diagnose primary empty sella most often in adults between 30 and 40 years old. Women often receive this finding earlier in life than men, especially women who have had full-term pregnancies.

Children rarely get primary empty sella. When children do have it, doctors often look for connected genetic or developmental conditions like Turner syndrome or Prader-Willi syndrome.

How Common Is This Condition?

Empty Sella Syndrome is a rare condition. Studies suggest that fewer than 1 percent of people with an empty sella ever develop actual symptoms.

However, finding an empty sella without symptoms is quite common. Autopsy and scan studies show that up to 35 percent of the general population may have an empty sella without knowing it.

Symptoms of Empty Sella Syndrome.

Chronic headaches are the most common symptom linked to Empty Sella Syndrome. However, doctors are still studying whether the flat pituitary gland directly causes the head pain or if high blood pressure plays a role.

When ESS damages your pituitary gland, your hormone levels drop. The exact symptoms depend on which hormones your body lacks:

• Milky nipple discharge called galactorrhea in women or men.
• Erectile dysfunction in men.
• Irregular menstrual periods or complete absence of periods in women.
• Low sexual desire or libido.
• Constant fatigue and lack of energy.

In rare cases, people with ESS may experience these additional signs:

• Benign intracranial pressure inside the skull.
• Cerebrospinal fluid leaking from the nose.
• Swelling of the optic nerve disk inside the eye due to high pressure.
• Vision changes like blurry vision.

Remember that many people live their entire lives with an empty sella and experience zero symptoms.

Does Empty Sella Syndrome Cause Weight Gain?

Yes, weight gain can happen if Empty Sella Syndrome lowers your levels of thyroid-stimulating hormone (TSH).

TSH tells your thyroid gland to make thyroid hormones. These hormones control your body's speed of burning energy, known as your metabolic rate.

If your pituitary gland fails to make enough TSH, your thyroid slows down. A slow metabolism makes it much easier to gain extra body weight.

Causes of Empty Sella Syndrome.

Empty Sella Syndrome results from either a primary cause or a secondary cause. Secondary causes are much more likely to trigger real symptoms.

Causes of Primary Empty Sella.

Primary empty sella happens when a thin brain membrane dips into your sella turcica and flattens the pituitary gland against the bone.

Doctors still do not know the exact cause behind primary empty sella.

One leading theory suggests a slight natural weakness in the brain membranes lets spinal fluid push into the saddle area. Even though the gland looks flat on scans, it usually keeps working normally.

Causes of Secondary Empty Sella.

Secondary empty sella occurs when a known disease, injury, or medical treatment damages your pituitary gland or bone pocket.

Common causes of secondary empty sella include:

• Brain tumors.
• Radiation therapy to the head.
• Previous brain surgery near the pituitary gland.
• Severe traumatic brain injury from an accident.

Other specific medical causes include:

• Brain tumors: Growths inside the skull that raise intracranial pressure and compress the gland.
• Idiopathic intracranial hypertension (IIH): A condition where extra cerebrospinal fluid builds up, raising pressure inside your skull.
• Pituitary adenomas: Non-cancerous growths on the pituitary gland that can damage surrounding tissue.
• Sheehan's syndrome: A rare condition caused by severe blood loss during childbirth that cuts off oxygen to the pituitary gland.

How Doctors Diagnose Empty Sella Syndrome.

Doctors usually find an empty sella by accident when reviewing head scans ordered for unrelated reasons like sinus pain or headaches.

If you have symptoms like hormone imbalances or severe headaches, your doctor will review your medical history, perform a physical exam, and order advanced imaging.

Diagnostic tools for Empty Sella Syndrome include:

• Computed tomography (CT) scan: Uses X-rays and computer processing to create detailed cross-sectional pictures of your brain.
• Magnetic resonance imaging (MRI) scan: Uses powerful magnets and radio waves to generate high-resolution images of your sella turcica and pituitary gland.

Your doctor may also order blood tests to check your hormone levels and ensure your endocrine system functions correctly.

In certain situations, doctors check your intracranial pressure using:

• An eye exam by an optometrist or ophthalmologist to check your retina.
• A lumbar puncture, also called a spinal tap, to measure the pressure of your spinal fluid.

Treatments for Empty Sella Syndrome.

If your scan shows an empty sella but your pituitary gland works normally, you do not need any medical treatment.

However, if ESS causes hormone deficiencies, your doctor will prescribe hormone replacement medicines tailored to your specific needs.

If cerebrospinal fluid leaks from your nose due to high pressure, a surgeon may need to repair your sella turcica.

Risk Factors for Empty Sella Syndrome.

Doctors are still learning why some people develop symptoms while others do not. However, secondary empty sella carries a much higher risk of developing ESS than primary empty sella.

Having a history of brain tumors, radiation therapy, or severe head trauma increases your chances of having pituitary symptoms.

Prognosis for Empty Sella Syndrome.

The long-term outlook for people with Empty Sella Syndrome is very positive.

Hormone replacement medicines effectively manage low hormone levels. If you have hormone deficiencies from ESS, you may need to take daily medicines for the rest of your life to stay healthy.

A Note from Dr. Priya Sammani.