Empty Sella Syndrome (ESS): Causes, Symptoms & Treatment

What is empty sella syndrome (ESS)?

Empty sella syndrome (ESS) is a rare condition in which your pituitary gland becomes flattened or shrinks due to issues with the contents within the sella turcica. The sella turcica is a bony structure at the base of your brain that surrounds and protects your pituitary gland.

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The sella turcica is a saddle-like compartment. In Latin, it means “Turkish seat.” ESS causes certain symptoms, including hormonal imbalances, frequent headaches and vision changes.

Your pituitary gland is a small gland located at the base of your brain below your hypothalamus. It’s a part of your endocrine system and is in charge of making many different important hormones. These hormones affect and control other glands in your endocrine system.

What’s the difference between empty sella and empty sella syndrome?

Some information sources use “empty sella syndrome” and “empty sella” interchangeably, but they’re slightly different. In short, empty sella is a radiological finding and empty sella syndrome is a condition.

Empty sella is a radiological finding of a flattened pituitary gland. When your pituitary gland shrinks or becomes flattened, your healthcare provider can’t see it on imaging scans. This makes the area of the pituitary gland — the sella turcica — look empty, hence the name “empty sella.”

However, the sella turcica isn’t actually empty. It’s often filled with cerebrospinal fluid (CSF). CSF is fluid that surrounds your brain and spinal cord. With empty sella, CSF has leaked into the sella turcica, which puts pressure on your pituitary gland. This causes the gland to shrink or flatten.

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Often, healthcare providers discover empty sellas by chance (incidentally) on a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan when people are being evaluated for other reasons.

People can have an empty sella on their imaging results without having any symptoms — their pituitary gland functions as it should.

If someone has an empty sella and their pituitary gland isn’t functioning properly, it’s called empty sella syndrome (ESS). A syndrome is a set of medical signs and symptoms that are correlated with each other and often associated with a particular condition. People with ESS can experience hormonal imbalances, vision changes and frequent headaches.

What are the two types of empty sella?

When your healthcare provider identifies an empty sella on your imaging scans, they categorize it as one of two types: primary or secondary.

Primary empty sella (PES) means that your provider can’t identify the underlying cause of your flattened pituitary gland. Primary empty sella doesn’t usually cause empty sella syndrome. In other words, it doesn’t usually cause symptoms.

Secondary empty sella (SES) is caused by an identifiable underlying condition that changes the anatomy of your pituitary gland and/or the sella turcica. This is usually due to some kind of damage as a result of a condition or incident.

Secondary empty sella (SES) more often leads to empty sella syndrome than PES.

Is empty sella syndrome (ESS) life-threatening?

Empty sella syndrome (ESS) isn't life-threatening. It’s treatable with hormone medications and sometimes surgery.

Having an empty sella show up on your brain imaging scan is also not life-threatening. Most cases of empty sella don't lead to empty sella syndrome or any symptoms.

What does the pituitary gland do?

Your pituitary gland is an important endocrine gland that’s in charge of making many different hormones. It also tells other endocrine system glands to release hormones, including your:

• Adrenal glands.
• Ovaries or testicles.
• Thyroid gland.

Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, muscles and other tissues. These signals tell your body what to do and when to do it.

Your pituitary gland is connected to your hypothalamus through a stalk of blood vessels and nerves. This is called the pituitary stalk. Through the stalk, your hypothalamus communicates with your pituitary gland and tells it to release certain hormones. Your hypothalamus is the part of your brain that controls functions like blood pressure, heart rate, body temperature and digestion.

Your pituitary gland makes the following hormones:

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• Adrenocorticotropic hormone (ACTH or corticotropin).
• Antidiuretic hormone (ADH, or vasopressin).
• Follicle-stimulating hormone (FSH).
• Growth hormone (GH).
• Luteinizing hormone (LH).
• Oxytocin.
• Prolactin.
• Thyroid-stimulating hormone (TSH).

Your pituitary gland doesn’t produce and release all of these hormones continuously. Most are released in bursts every one to three hours.

Who does empty sella syndrome (ESS) affect?

Though it’s rare, both children and adults can develop empty sella syndrome (ESS).

Women are four times more likely to have primary empty sella (PES) — not necessarily empty sella syndrome — than men.

PES most commonly occurs between the ages of 30 and 40 years old. It sometimes develops earlier in women than men.

Women are even more likely to have PES if they’ve had a full-term pregnancy.

PES occurs less frequently in children than in adults. In these cases, it’s often associated with other conditions, including:

• Turner syndrome.
• Moyamoya disease.
• Bartter’s syndrome.
• Nevoid basal cell carcinoma syndrome.
• Hunter syndrome.
• Prader–Willi syndrome.
• Alstrom syndrome.
• Meniere’s Disease.
• Erdheim–Chester disease.

How common is empty sella syndrome (ESS)?

Empty sella syndrome (ESS) is rare. Some researchers estimated that less than 1% of people with an empty sella develop symptoms (develop empty sella syndrome).

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Having an empty sella without symptoms is much more common. Reports estimate that 8% to 35% of the population have an empty sella. Based on results from neuroimaging testing, other reports estimate that empty sella occurs in 12% of people.