Empty sella syndrome
Empty sella syndrome is common in women who are overweight or have high blood pressure. Characterized by an enlarged bony structure (sella turcica) that houses the pituitary gland at the base of the brain, the disorders sometimes results in high
fluid pressure inside the skull. The pituitary gland is usually normal size or small.
In empty sella syndrome, the sella turcica (the bony structure at the base of the brain that houses the pituitary gland) enlarges, but the pituitary remains normal-sized or shrinks. People with empty sella syndrome have a defect in the tissue barrier that normally keeps the cerebrospinal fluid around the brain separate from the sella turcica. As a result, cerebrospinal fluid puts increased pressure on the pituitary gland and the walls of the sella turcica. The sella turcica may enlarge, and the pituitary gland may shrink.
Empty sella is a radiological diagnosis based on CT or MR investigation. Either a normal sized (empty sella) or enlarge sella (empty enlarged sella) presents partly or totally filled with cerebrospinal fluid. The radiological diagnosis does not mean a pathological situation in every instance. Many patients present without specific symptoms and the diagnosis is made by chance. Empty sella syndrome is the pathological variant of a radio logically verified empty sella. Primary empty sella is an idiopathic form of an empty sella which occurs in the absence of prior pituitary surgery or radiation therapy or medication with DOPA agonists. Secondary empty sella occurs as a result of surgical resection or irradiation of a sellar expansion.
The empty sella syndrome may produce no symptoms at all and seldom produces serious symptoms. About half of those affected have headaches, and some people have high blood pressure as well. In rare cases, there is leaking of the cerebrospinal fluid from the nose or problems with vision. Each individual may experience symptoms differently. Besides high fluid pressure in the skull, which occurs in about 10 percent of patients, another symptom is a chronically runny nose. Empty sella has been associated with pseudotumor cerebri, hypopituitarism, visual field defects, and headache. Headache is the most common symptom. Visual alterations may be due to traction on the chiasm or involvement of chiasmal blood vessels. There is general agreement in the literature that anterior pituitary dysfunction necessitating hormonal replacement therapy is rare in primary empty sella syndrome. Pituitary hypertsecretioon strongly points to the presence of a pituitary adenoma that is partly necrosed.
The empty sella syndrome can be diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI) scanning. Pituitary function is checked to rule out hormone excess or deficiency, but is almost always normal.
Unless the disorder results in other medical problems, treatment is symptomatic and supportive. In some cases, surgery may be needed. Treatment is indicated only for overproduction or underproduction of pituitary hormones and is seldom needed.