From the Guidelines
The diagnosis and treatment of Empty Sella Syndrome, whether primary or secondary, should focus on identifying and managing any underlying hormonal deficiencies, with treatment tailored to the specific needs of the patient, as evidenced by the most recent guidelines on neuroendocrine imaging 1. The condition is characterized by the herniation of the subarachnoid space into the sella turcica, which can lead to hypopituitarism in approximately 30% of patients 1. Key considerations in the diagnosis include:
- Identifying the presence of any mass lesions, such as prolactin-secreting adenomas, germ-line tumors, meningioma, craniopharyngioma, or Rathke cleft cyst, which can cause hypopituitarism 1
- Recognizing that metastatic lesions, sarcoid, and other inflammatory processes may also involve the sella and parasellar regions 1
- Understanding that an empty sella can be an incidental finding, but close monitoring is necessary due to the potential for hypopituitarism 1 Treatment approaches may include:
- Hormone replacement therapy, such as levothyroxine for hypothyroidism, hydrocortisone for adrenal insufficiency, or sex hormone replacement when needed
- Consultation with a neurosurgeon for patients with visual disturbances or persistent headaches, although surgery is rarely necessary
- Regular follow-up with an endocrinologist to monitor pituitary function over time, as some patients may develop progressive hormonal deficiencies 1.
From the Research
Diagnosis of Empty Sella Syndrome
The diagnosis of Empty Sella Syndrome (ESS) involves a combination of clinical evaluation, laboratory tests, and imaging studies. The syndrome can be primary or secondary, with primary empty sella (PES) being characterized by the herniation of the subarachnoid space within the sella turcica without any previous pituitary pathologies 2. Secondary empty sella, on the other hand, occurs after treatment of pituitary tumors or other pituitary pathologies 3.
- Clinical presentation: Patients with ESS may present with symptoms such as headache, irregular menses, overweight/obesity, and visual disturbances 2.
- Laboratory tests: Hormonal evaluation, including serum thyroid stimulating hormone, T4, cortisol, prolactin, total testosterone, follicle stimulating hormone, leutinizing hormone, and fasting Insulin like Growth factor 1 (IGF 1) 4.
- Imaging studies: CT or MRI scans to confirm the presence of an empty sella turcica 4, 5.
Treatment of Empty Sella Syndrome
The treatment of ESS depends on the presence and severity of hormonal deficiencies and other symptoms.
- Hormone replacement therapy: For patients with hormonal deficiencies, such as growth hormone deficiency or hypopituitarism 4, 3.
- Management of symptoms: Treatment of symptoms such as headache, visual disturbances, and other neurological symptoms 2, 3.
- Multidisciplinary approach: A multidisciplinary approach, including endocrine, neurologic, and ophthalmologic expertise, is recommended for the diagnosis, management, and follow-up of ESS 2, 3.
- Routine endocrine evaluation: Patients with PES should undergo routine endocrine evaluation to detect hormonal deficiencies early and institute appropriate replacement therapy 4.