From the Guidelines
No, an empty sella (sella turcica) does not typically cause elevated cortisol levels. An empty sella is a radiological finding where the pituitary gland appears flattened or smaller than normal within the sella turcica cavity, which may be filled with cerebrospinal fluid. While the pituitary gland does influence cortisol production through ACTH (adrenocorticotropic hormone), an empty sella is more commonly associated with normal or decreased hormone production rather than elevated levels, as noted in a study on neuroendocrine imaging 1.
Some key points to consider include:
- The pituitary gland's role in regulating cortisol production is well-established, but an empty sella is not typically a cause of elevated cortisol levels.
- Elevated cortisol levels, known as hypercortisolism or Cushing's syndrome, are typically caused by other conditions such as pituitary adenomas (Cushing's disease), adrenal tumors, or exogenous steroid use.
- If an empty sella finding and elevated cortisol levels coexist, these are likely unrelated issues, and the cause of high cortisol should be investigated separately through tests like 24-hour urinary free cortisol, late-night salivary cortisol, or dexamethasone suppression tests, as part of a complete endocrine evaluation to determine the source of elevated cortisol. It's also worth noting that approximately 30% of patients with an empty sella may demonstrate some hypopituitarism upon testing, as mentioned in the study on neuroendocrine imaging 1, further supporting the idea that an empty sella is more likely to be associated with decreased rather than elevated hormone production.
From the Research
Elevated Cortisol Levels and Empty Sella
- Elevated cortisol levels are not typically associated with empty sella syndrome, as most patients with this condition suffer from hypopituitarism, which can lead to decreased cortisol production 2, 3, 4, 5, 6.
- However, there is no direct evidence to suggest that empty sella syndrome can cause elevated cortisol levels.
- Some studies have reported cases of isolated ACTH deficiency associated with primary empty sella turcica, which can lead to decreased cortisol production 3.
- Other studies have found that empty sella syndrome can be associated with hypopituitarism, including decreased production of cortisol 2, 4, 5, 6.
- It is essential to note that the relationship between empty sella syndrome and cortisol levels is complex and may vary depending on the individual case and the presence of other endocrine disorders.
Endocrine Disorders and Empty Sella
- Empty sella syndrome can be associated with various endocrine disorders, including hypopituitarism, primary hypothyroidism, and hyperprolactinemia 2, 3, 4, 5, 6.
- The syndrome can also be associated with neurological symptoms, such as headaches and visual disturbances, due to the possible coexistence of idiopathic intracranial hypertension 4.
- A multidisciplinary approach, including endocrine, neurological, and ophthalmological experts, is recommended for the proper diagnosis, management, and follow-up of empty sella syndrome 4.