From the Guidelines
Partial empty sella syndrome in a 30-year-old female should be diagnosed with MRI of the brain with focus on the sella turcica, as it is the gold standard imaging technique, showing CSF within the sella and a thinned pituitary gland, as recommended by the American College of Radiology Appropriateness Criteria 1. The condition often presents with headaches, visual disturbances, and possible hormonal imbalances, and may be asymptomatic, with the condition discovered incidentally during brain imaging for unrelated reasons. When symptoms do occur, they may include:
- Chronic headaches
- Visual field defects
- Papilledema
- Menstrual irregularities
- Galactorrhea
- Fatigue
- Decreased libido Diagnostic workup should begin with a thorough clinical history and physical examination, followed by comprehensive hormonal testing including:
- Prolactin
- Thyroid function tests
- Cortisol levels
- Growth hormone
- Gonadotropins to assess pituitary function Visual field testing is important to evaluate for any optic chiasm compression. For asymptomatic patients with normal hormonal profiles, no specific treatment is needed beyond periodic monitoring. If hormonal deficiencies are identified, appropriate hormone replacement therapy should be initiated based on the specific deficiencies, as suggested by the guidelines for neuroendocrine imaging 1. The prognosis is generally good, especially when the condition is identified early and any hormonal imbalances are properly managed.
From the Research
Signs and Symptoms
- The signs and symptoms of a partial empty sella can vary, but may include headache, obesity, visual disturbance, non-traumatic CSF rhinorrhea, and pituitary insufficiency 2
- Endocrine pituitary disorders, defined as at least one hormone deficit, were reported in 19% to 40% of patients with empty sella 3
- Pituitary hormonal dysfunction, such as hypopituitarism, and/or neurological symptoms due to the possible coexistence of idiopathic intracranial hypertension may also occur 4
- In children, empty sella is more likely to be associated with clinical symptoms and endocrinopathies, particularly growth hormone deficiency, hypogonadotropism, or multiple pituitary hormone deficiencies 5
Diagnostic Workup
- Magnetic resonance imaging (MRI) is useful in diagnosing empty sella and is considered the gold standard for radiological diagnosis 2, 3
- A multidisciplinary approach with the integration of endocrine, neurological, and ophthalmological experts is strongly advocated for the proper diagnosis, management, and follow-up of empty sella syndrome 4
- Hormonal pituitary evaluation should be assessed at the moment of the diagnosis, along with a careful imaging using MRI 3
- If no alterations are detected, it is suggested to have a careful revaluation at 24-36 months, in relation to the low risk of progression to empty sella syndrome 3