Differential Diagnosis for Nonspecific, Partial Empty Sella Configuration

• Single Most Likely Diagnosis
  • Primary empty sella syndrome: This condition occurs when the sella turcica, which houses the pituitary gland, appears empty or partially empty due to a defect in the diaphragma sellae, allowing cerebrospinal fluid to fill the space. It is often an incidental finding and may not cause symptoms.
• Other Likely Diagnoses
  • Partially empty sella syndrome secondary to surgery or radiation: Previous surgical or radiation treatment in the sellar region can lead to a partial empty sella appearance due to the removal or shrinkage of pituitary tissue.
  • Pituitary apoplexy with partial resolution: Pituitary apoplexy is a condition where the pituitary gland suddenly hemorrhages or becomes infarcted. Over time, the hemorrhage or infarcted tissue may partially resolve, leaving a partially empty sella appearance.
  • Lymphocytic hypophysitis: This is an inflammatory condition of the pituitary gland that can cause it to shrink, potentially leading to a partial empty sella appearance.
• Do Not Miss Diagnoses
  • Pituitary adenoma with cystic degeneration: Although less common, a pituitary adenoma (tumor) that undergoes cystic degeneration can mimic a partial empty sella. Missing this diagnosis could lead to delayed treatment of a potentially significant tumor.
  • Craniopharyngioma: These are rare, usually benign tumors that arise near the pituitary gland and can cause it to appear partially empty due to compression or cystic components.
  • Rathke's cleft cyst: A benign cystic lesion in the sellar region that can compress the pituitary gland, giving the appearance of a partial empty sella.
• Rare Diagnoses
  • Arachnoid cyst: A rare condition where a cyst filled with cerebrospinal fluid forms in the sellar region, potentially compressing the pituitary gland and giving a partial empty sella appearance.
  • Sellar or suprasellar germinoma: A rare type of tumor that can occur in the sellar or suprasellar region, potentially causing a partial empty sella appearance due to compression or infiltration of the pituitary gland.
  • Hypophysitis due to other causes (e.g., granulomatous, xanthomatous): Other rare inflammatory conditions of the pituitary gland that can lead to its shrinkage and a partial empty sella appearance.