From the Guidelines
Empty sella syndrome often presents with symptoms related to pituitary dysfunction, including headaches, vision problems, fatigue, menstrual irregularities in women, decreased libido, and erectile dysfunction in men, and hormone replacement therapy becomes necessary when the syndrome causes significant hormonal deficiencies, such as TSH or adrenal insufficiency, which may require levothyroxine or hydrocortisone replacement, respectively. The symptoms of empty sella syndrome can vary widely among patients, but common complaints include headaches, fatigue, and visual disturbances, as well as endocrine symptoms like menstrual irregularities or decreased libido 1. Hormone replacement therapy is a critical component of managing empty sella syndrome when hormonal deficiencies are present, with the goal of alleviating symptoms and improving quality of life. Key considerations in hormone replacement include:
- TSH deficiency, which may require levothyroxine replacement, typically starting at a low dose (e.g., 25-50 mcg daily) and adjusting based on free T4 levels 1
- Adrenal insufficiency, which requires hydrocortisone replacement, usually in a dose of 15-25 mg daily divided into 2-3 doses, with the caveat that steroids should be initiated before thyroid hormone replacement to avoid precipitating an adrenal crisis 1
- Other potential hormone replacements, such as growth hormone, sex hormones (estrogen or testosterone), or desmopressin for diabetes insipidus, depending on the specific hormonal deficiencies identified It is essential to note that not all patients with empty sella syndrome will require hormone replacement, as the condition can be asymptomatic or result in minimal hormonal disruption. Treatment decisions should be based on comprehensive hormonal testing and a thorough evaluation of symptoms, with regular endocrinological follow-up to monitor hormone levels and adjust replacement therapy as needed 1.
From the Research
Symptoms of Empty Sella Syndrome
The symptoms of empty sella syndrome can vary, but common complaints include:
- Generalized weakness and fatiguability 2
- Hyponatremia 2
- Endocrine abnormalities, such as hypocortisolemia, hypothyroidism, hypogonadism, hyperprolactinemia, and growth hormone deficiency 3, 4
- Neurological symptoms, such as those associated with idiopathic intracranial hypertension 5
Hormone Replacement Therapy
Hormone replacement therapy may be necessary for some patients with empty sella syndrome, particularly those with hormonal deficiencies. The specific hormones that may need to be replaced include:
- Thyroid-Stimulating Hormone (TSH) or thyroid hormones, in cases of hypothyroidism 3, 4
- Hydrocortisone, in cases of hypocortisolemia or adrenal insufficiency 3, 4
- Growth hormone, in cases of growth hormone deficiency 3
- Sex hormones, in cases of hypogonadism 3 The decision to initiate hormone replacement therapy should be made on a case-by-case basis, taking into account the individual patient's symptoms, laboratory results, and overall clinical picture 6, 5
Diagnosis and Evaluation
A thorough diagnostic evaluation, including laboratory tests and imaging studies, such as magnetic resonance imaging (MRI), is necessary to diagnose empty sella syndrome and determine the need for hormone replacement therapy 2, 6, 5. Regular follow-up and monitoring are also important to assess the effectiveness of treatment and detect any potential complications or progression of the disease 6, 5.