Differential Diagnosis for Partially Empty Sella
The presence of a partially empty sella can be due to various causes, ranging from benign to life-threatening conditions. Here's a categorized differential diagnosis:
- Single Most Likely Diagnosis
- Primary empty sella syndrome: This condition occurs when the sella turcica, which houses the pituitary gland, is partially or completely filled with cerebrospinal fluid, often due to a defect in the diaphragma sellae. It's usually asymptomatic and discovered incidentally on imaging studies.
- Other Likely Diagnoses
- Pituitary tumor (e.g., adenoma) with suprasellar extension: Tumors of the pituitary gland can cause erosion or expansion of the sella turcica, leading to a partially empty appearance on imaging.
- Lymphocytic hypophysitis: An inflammatory condition of the pituitary gland that can cause it to shrink, giving the appearance of an empty sella.
- Sheehan syndrome: Postpartum necrosis of the pituitary gland, which can result in a partially empty sella.
- Do Not Miss Diagnoses
- Pituitary apoplexy: A medical emergency where a pituitary tumor undergoes sudden hemorrhage or infarction, which can lead to acute symptoms and requires immediate attention.
- Craniopharyngioma: A type of brain tumor that can occur above the pituitary gland and may extend into the sella, causing it to appear partially empty.
- Meningioma: A tumor arising from the meninges that can compress or invade the sella turcica.
- Rare Diagnoses
- Sarcoidosis: A systemic inflammatory disease that can affect the pituitary gland and cause a partially empty sella.
- Histocytosis: A rare condition where abnormal immune cells accumulate in various parts of the body, including the pituitary gland.
- Arachnoid cyst: A rare congenital condition where a cyst forms in the arachnoid membrane surrounding the brain, potentially compressing the pituitary gland and giving the appearance of an empty sella.
Each of these diagnoses has distinct clinical and radiological features that can help guide the diagnostic process. A thorough medical history, physical examination, laboratory tests, and imaging studies are essential for determining the underlying cause of a partially empty sella.