Empty Sella Syndrome

What is Empty Sella Syndrome?

Empty sella syndrome is a condition where the sella turcica, a small bony structure at the base of your skull, appears empty on imaging scans. The sella turcica normally holds your pituitary gland, a pea-sized organ that controls many of your hormones. In empty sella syndrome, cerebrospinal fluid, the clear fluid that surrounds your brain and spinal cord, pushes into this space and flattens the pituitary gland against the floor of the skull.

This can happen in two ways. Primary empty sella syndrome occurs when a small opening in the tissue covering the pituitary allows fluid to enter the space. Secondary empty sella syndrome develops after pituitary surgery, radiation therapy, or when a pituitary tumor shrinks. Most people with this condition have the primary type.

Many people with empty sella syndrome have no symptoms at all. The pituitary gland often continues to work normally despite being compressed. However, some people experience hormonal changes because the physical distortion affects how the gland receives signals from the brain. This can lead to mild hormone imbalances that show up in blood tests.

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Symptoms

Headaches that may feel like pressure or tightness
Vision problems including blurred or double vision
Irregular menstrual periods in women
Unexpected breast milk production
Fatigue and low energy levels
Reduced sex drive
Dizziness or lightheadedness
Fertility challenges

Most people with empty sella syndrome experience no symptoms at all. The condition is often discovered accidentally during brain scans done for other reasons. When symptoms do occur, they usually relate to mild hormone changes rather than serious pituitary damage.

Causes and risk factors

Primary empty sella syndrome happens when the membrane that normally separates your brain from the pituitary gland is too thin or has a small hole. This allows cerebrospinal fluid to press down on the pituitary gland over time. Risk factors include being female, having obesity, high blood pressure, and being over age 40. Women who have had multiple pregnancies face higher risk. Some people are born with anatomical differences that make them more likely to develop this condition.

Secondary empty sella syndrome results from direct injury to the pituitary gland. This includes surgery to remove pituitary tumors, radiation treatment to the head, sudden reduction in size of a pituitary tumor, or head trauma. Certain autoimmune conditions may also play a role. The condition can disrupt the normal connection between the hypothalamus and pituitary gland, affecting how dopamine reaches the gland to regulate hormone production.

How it's diagnosed

Empty sella syndrome is typically diagnosed using MRI or CT scans of the brain. These imaging tests show cerebrospinal fluid filling the sella turcica where the pituitary gland sits. The scans can reveal whether the pituitary gland is flattened or pushed to one side. Your doctor will also order blood tests to check your hormone levels and assess pituitary function.

Blood testing helps identify any hormonal imbalances caused by the condition. Prolactin levels are particularly important because empty sella syndrome can cause mild elevation through distortion of pituitary anatomy and disruption of dopamine delivery. Rite Aid offers prolactin testing as part of our flagship blood panel, available at Quest Diagnostics locations nationwide. Regular monitoring helps your doctor track changes and decide if treatment is needed.

Treatment options

No treatment needed for most cases without symptoms or hormone problems
Regular monitoring with blood tests to track hormone levels over time
Medications to lower prolactin if levels are elevated and causing symptoms
Hormone replacement therapy if pituitary function becomes impaired
Weight management through balanced nutrition and regular physical activity
Blood pressure control with diet, exercise, and medication if prescribed
Vision monitoring with regular eye exams if visual symptoms develop
Surgery only in rare cases with severe symptoms or cerebrospinal fluid leakage

Frequently asked questions

Empty sella syndrome occurs when cerebrospinal fluid fills the space around your pituitary gland, making the area look empty on scans. For most people, this condition is not dangerous and causes no symptoms. The pituitary gland usually continues to function normally even when compressed. Only a small number of people develop hormone imbalances that require treatment.

Most people with empty sella syndrome have no symptoms at all. When symptoms do occur, headaches are most common, often feeling like pressure at the base of the skull. Some people experience vision changes, irregular periods, unexpected breast milk production, or fatigue. These symptoms typically result from mild hormone changes rather than serious pituitary damage.

Doctors diagnose empty sella syndrome using MRI or CT scans that show cerebrospinal fluid in the sella turcica. Blood tests check hormone levels to assess pituitary function. Prolactin testing is particularly important because this condition can cause mild elevation. Many cases are discovered accidentally during brain imaging done for unrelated reasons.

Blood tests cannot directly detect empty sella syndrome, but they reveal hormone imbalances that may result from the condition. Prolactin levels are especially useful because empty sella syndrome can cause mild elevation through disruption of normal pituitary anatomy. Regular blood testing helps monitor pituitary function and guide treatment decisions when needed.

Primary empty sella syndrome develops when the membrane separating the brain from the pituitary gland is thin or has an opening. This allows cerebrospinal fluid to press on the gland over time. Secondary empty sella syndrome results from pituitary surgery, radiation, tumor shrinkage, or head trauma. Risk factors include obesity, high blood pressure, female sex, and multiple pregnancies.

Most people with empty sella syndrome need no treatment because their pituitary gland functions normally. Treatment becomes necessary only if blood tests show hormone imbalances or if symptoms develop. This may include medications to lower prolactin levels or hormone replacement therapy. Regular monitoring with blood tests helps doctors decide if and when treatment is needed.

Yes, empty sella syndrome can cause mild prolactin elevation. The physical distortion of the pituitary gland disrupts the normal delivery of dopamine, a brain chemical that keeps prolactin levels in check. This can lead to symptoms like irregular periods, breast milk production, or reduced sex drive. Blood testing confirms whether prolactin levels are elevated and helps guide treatment.

Yes, obesity and high blood pressure are both risk factors for primary empty sella syndrome. Excess weight and elevated blood pressure may increase cerebrospinal fluid pressure, pushing fluid into the sella turcica. Managing your weight through healthy eating and regular exercise may help reduce pressure. Controlling blood pressure also supports overall pituitary health.

Testing frequency depends on whether you have symptoms or hormone imbalances. People with no symptoms may only need annual blood tests to monitor pituitary function. Those with elevated prolactin or other hormone changes may need testing every few months initially, then less often once levels stabilize. Your doctor will create a monitoring schedule based on your specific situation.

Empty sella syndrome can affect fertility if it causes hormonal imbalances, particularly elevated prolactin levels. High prolactin can interfere with ovulation in women and reduce testosterone in men. However, many people with this condition have normal hormone levels and fertility. Blood testing identifies hormone problems early, and treatment can often restore normal reproductive function.