Do you sometimes get headaches all the time? Or do you think it's something to do with hormones? If a doctor says they need to do a ``(CT)`` scan of your head or an ``(MRI)`` scan, they might find that the area where your pituitary gland is located looks "empty." That's what we call an Empty Sell. But is it always a big problem? Let's talk about this in detail.
What is Empty Sella Syndrome (ESS)?
Simply put, Empty Sella Syndrome (ESS) is a very rare condition. It occurs when your pituitary gland – a small but very important gland located at the base of your brain – becomes flattened or shrunken in its place, a bony cavity called the sella turcica . Think of it this way, the sella turcica is like a little house that protects the pituitary gland. For some reason, this 'house' can become too big, causing the pituitary gland to bulge and become smaller.
The word 'sella turcica' comes from Latin, meaning 'Turkish seat'. It is named so because it resembles the shape of a horse's saddle. Some people with ESS can experience symptoms such as hormonal imbalances , frequent headaches , and vision changes .
Did you know that the pituitary gland is a very important part of our endocrine system , which is the hormone-producing system. It produces many important hormones in our body. These hormones control other glands in our body.
What is the difference between Empty Sella and Empty Sella Syndrome?
This is a bit confusing, so listen carefully. Although the terms 'empty cell' and 'empty cell syndrome' are sometimes used interchangeably, there is a slight difference. In short, an empty cell is a radiological finding , while empty cell syndrome is a medical condition.
'Empty Sella' is when your pituitary gland appears flattened or shrunken on a scan. In this case, doctors can't see the pituitary gland properly on the scan. Therefore, the space where the pituitary gland is located, called the sella turcica, looks 'empty'. That's where the name 'empty sella' comes from.
However, the sella turcica is not actually empty. Most of the time, it is filled with cerebrospinal fluid (CSF) . This CSF is the fluid that surrounds and protects our brain and spinal cord. In an 'empty sella' condition, this CSF fluid leaks into the sella turcica and puts pressure on the pituitary gland. That pressure causes the gland to shrink or flatten.
Most of the time, doctors discover this 'empty cell' by accident. That is, when they do a ``(CT)`` scan or ``(MRI)`` scan of the head for some other reason.
Even though some people have 'empty cells' on their scans, they can have no symptoms and their pituitary gland can function well.
However, if someone has an 'empty sella' and their pituitary gland is not working properly, that's what we call Empty Sella Syndrome (ESS) . A syndrome is a collection of related symptoms. People with ESS can experience things like hormonal imbalances, vision changes, and frequent headaches.
There are two types of Empty Sella, right?
Yes, when your scan detects an 'empty cell', doctors divide it into two types: primary and secondary.
- Primary Empty Sella (PES): This is when doctors can't find a clear cause for your pituitary gland to become flattened. In most cases, primary empty sella doesn't cause empty sella syndrome. This means that it rarely causes symptoms.
- Secondary Empty Sell (SES): This is caused by another identifiable condition that affects the structure of your pituitary gland or sella turcica. Simply put, it is caused by damage from another disease or event. In cases of secondary empty sella (SES), empty sella syndrome is more likely to develop than in cases of primary empty sella (PES).
Is this Empty Sella Syndrome (ESS) life-threatening?
No, Empty Sella Syndrome (ESS) is not a life-threatening condition. It can be treated with hormonal medications and sometimes surgery.
Also, just because your brain scan says 'empty cell' doesn't mean it's life-threatening. In most cases of 'empty cell', there are no symptoms or empty cell syndrome.
What is the role of the Pituitary Gland?
The pituitary gland is a very important endocrine gland in our body. It produces many different hormones. It also tells the other glands in our endocrine system to release hormones. That is:
- Adrenal glands
- Ovaries (in women) or testicles (in men)
- Thyroid gland
Hormones are like chemical messengers. They travel through the blood and carry messages to our organs, muscles, and other tissues. These messages tell the body what to do and when to do it.
The pituitary gland is connected to the hypothalamus in our brain by a stalk made of blood vessels and nerves. This is called the pituitary stalk. It is through this stalk that the hypothalamus talks to the pituitary gland and says, 'Okay, now release these hormones.' The hypothalamus is the part of our brain that controls things like blood pressure, heart rate, body temperature, and digestion.
The pituitary gland mainly produces the following hormones:
- Adrenocorticotropic hormone (ACTH): This stimulates the adrenal glands to produce hormones (e.g. cortisol) that respond to stress.
- Antidiuretic hormone (ADH or vasopressin): Controls the body's water balance.
- Follicle-stimulating hormone (FSH): Helps mature eggs in women and produce sperm in men.
- Growth hormone (GH): Helps our bodies grow from childhood to adulthood, especially in bones and muscles.
- Luteinizing hormone (LH): Works with FSH to help the reproductive system function. It is important for ovulation in women and for the production of testosterone in men.
- Oxytocin: Helps the uterus contract during childbirth and milk let-down during breastfeeding.
- Prolactin: Stimulates the production of breast milk.
- Thyroid-stimulating hormone (TSH): Tells the thyroid gland in the neck to make thyroid hormones. These thyroid hormones control the rate at which our body uses energy (metabolism).
Not all of these hormones are produced continuously. Most are released in bursts, about every one to three hours.
Who is most affected by Empty Sella Syndrome (ESS)?
Although this is a rare condition, both children and adults can develop empty sella syndrome (ESS).
However, primary empty cell (PES) – meaning the one that is only seen on a scan without any symptoms – is about four times more common in women than in men.
PES is most common in people between the ages of 30 and 40. It can sometimes occur earlier in women than in men. Women who have had a full-term pregnancy are particularly at risk of developing PES.
PES is less common in children than in adults. When it occurs, it is often associated with other medical conditions, such as Turner syndrome, Moyamoya disease, and Prader–Willi syndrome.
How common is this?
Empty Sella Syndrome (ESS) is very rare. Some researchers estimate that less than 1% of people with 'empty sella' develop symptoms (i.e., develop ESS).
However, having an empty sella without symptoms is much more common. Some reports suggest that between 8% and 35% of the population may have an empty sella. Other reports suggest that around 12% of people have an empty sella, based on brain scan results.
What are the symptoms of Empty Sella Syndrome (ESS)?
The main symptom associated with empty sella syndrome (ESS) is chronic headaches. However, researchers are still not sure whether these headaches are caused by ESS or if they are just a coincidence. This is because many people with ESS also have high blood pressure (hypertension), which can also cause headaches if it becomes severe.
ESS usually causes hormonal imbalances due to damage to the pituitary gland. People with ESS may experience different symptoms depending on the damage to their pituitary gland and which hormones are affected. If you have ESS, you may have some of the following symptoms:
- Non-milky discharge from the breasts (galactorrhea) (this can also happen to men)
- Erectile dysfunction ( for men)
- Irregular menstruation or complete absence of menstruation (amenorrhea) (for women)
- Decreased or loss of sexual desire (low libido)
- Feeling tired all the time (Fatigue)
Very rarely, some people with ESS may also experience symptoms like:
- Increased pressure inside the skull (benign intracranial pressure)
- Cerebrospinal rhinorrhea (CSF leakage from the nose)
- Swelling of the optic disc inside the eye (papilledema) due to increased pressure in the skull
- Vision changes, for example, blurred vision.
Again, you can have an 'empty cell' on a brain scan, but you may not have any symptoms. In fact, many people with 'empty cells' do not have any symptoms and never will.
Does Empty Sella Syndrome (ESS) cause weight gain?
If your pituitary gland does not produce enough thyroid-stimulating hormone (TSH) due to empty sella syndrome (ESS), there is a chance that you will gain weight.
TSH stimulates the thyroid gland, located in the front of your neck, under the skin, to release thyroid hormones. The thyroid gland's main job is to produce thyroid hormones, which control the rate at which you convert the food you eat into energy, or your metabolic rate .
If your pituitary gland is not producing enough TSH due to ESS, your thyroid gland may not be producing enough thyroid hormones. This can cause your metabolism to slow down due to low thyroid hormone levels, which can lead to weight gain.
What causes Empty Sella Syndrome (ESS)?
Empty Sella Syndrome (ESS) can be caused by either primary empty sella (PES) or secondary empty sella (SES). However, secondary empty sella (SES) is more likely to cause ESS.
Causes of Primary Empty Sella Syndrome (PES)
Primary esophagitis (PES) occurs when one of the membranes that covers the outside of your brain (the arachnoid layer), the sella turcica, bulges inward, pressing on the pituitary gland.
Doctors still have not been able to pinpoint the exact cause of primary empty sella syndrome.
One theory is that a congenital weakness in the tissue covering the brain allows cerebrospinal fluid (CSF) to enter the sella turcica, flattening the pituitary gland. In such cases, the pituitary gland is often difficult to see on a scan, but it is often functioning normally, so empty sella syndrome does not occur.
Causes of Secondary Erectile Dysfunction (SES)
Secondary empty sella (SES) occurs when your pituitary gland or sella turcica is damaged by another disease or event. Therefore, there are many possible causes of SES. In general, the main causes of this damage are:
- A brain tumor .
- Radiation therapy .
- Brain surgery performed in the area surrounding the pituitary gland.
- A severe head injury, for example a traumatic brain injury.
Here are some other specific causes that can affect secondary emptying of the bladder:
- Brain tumors: Sometimes brain tumors can cause increased pressure around your brain (intracranial pressure), which can press on the pituitary gland.
- Idiopathic intracranial hypertension (IIH): IIH is an increase in pressure inside the skull due to a buildup of cerebrospinal fluid (CSF) around your brain. This excess pressure can compress the pituitary gland.
- Pituitary adenomas: These are tumors that develop in the pituitary gland. Most of the time, they are noncancerous (benign). These adenomas can put pressure on the pituitary gland and damage it.
- Sheehan's syndrome: This is a condition that can sometimes occur if there is excessive, life-threatening bleeding during childbirth. This can cause the body to lack oxygen and damage the pituitary gland.
How is Empty Sella Syndrome (ESS) diagnosed?
Most of the time, doctors find an empty sella by accident, when they do a head scan for another reason. Also, many people with an empty sella never develop empty sella syndrome or experience any symptoms.
However, if you have symptoms related to empty cell syndrome, such as frequent headaches and hormonal imbalances, your doctor will ask you about your medical history, perform a physical examination, and most likely order a head and brain scan.
The scans used to diagnose ESS are:
- A brain CT (computed tomography) scan: A CT scan is a method of taking clear pictures of your brain and pituitary gland using X-rays and a computer.
- A magnetic resonance imaging (MRI) scan of the brain: An MRI scan uses radio waves and strong magnets to make very clear pictures of parts inside your body, such as your sella turcica.
Your doctor may also order additional tests, such as blood tests, to check your hormone levels.
Sometimes, doctors may also do tests like these to check for increased pressure in your brain:
- Have an ophthalmologist examine the retina inside your eye.
- Lumbar puncture (spinal tap) – This measures the pressure of the spinal fluid.
What are the treatments for Empty Sella Syndrome (ESS)?
Even if your scans show an 'empty cell', if your pituitary gland is working well, you won't need any treatment. This is what happens most of the time.
However, if you have Empty Sella Syndrome (ESS) and your pituitary gland is not working properly, the treatment is medications to correct the low hormone levels. That is, the medication is determined based on which hormone is low.
If ESS causes cerebrospinal fluid (CSF) to leak from your nose (CSF rhinorrhea), you may need surgery to repair your sella turcica.
What are the risk factors for Empty Sella Syndrome (ESS)?
Doctors aren't sure exactly what causes empty sella syndrome in some people with empty sella. However, empty sella syndrome is more likely to develop with secondary empty sella (SES) than with primary empty sella (PES). This means that if the empty sella is caused by something else, such as a brain tumor, radiation therapy, or a head injury, you're more likely to experience symptoms.
What is the prognosis for someone with Empty Sella Syndrome (ESS)?
The outlook for someone with empty sella syndrome (ESS) is generally good. There are medications to treat hormonal imbalances. If you have hormonal imbalances due to ESS, you may need to take medication for the rest of your life.
When should you see a doctor if you have empty cell syndrome?
If you have been diagnosed with Empty Sella Syndrome (ESS), and you develop new symptoms or if your existing symptoms worsen, see your doctor immediately.
If you are taking medication for hormonal imbalances due to empty stomach syndrome, it is very important to see your doctor regularly to make sure your medication is working properly.
So, what should we remember from this?
Well, Empty Sella Syndrome (ESS) is actually a very rare condition. However, it is quite common to find out that you have something called an 'empty cell' on a brain scan. So don't be alarmed just because a doctor says so. Most of the time, people with 'empty cell' don't have any symptoms and don't develop Empty Sella Syndrome.
If you have any questions about your scan report, don't be afraid to ask your doctor. They are there to help you. Taking care of your health is the most important thing.
` Empty Sella Syndrome, Pituitary gland, Hormones, Brain scan, Sellae Tursica
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