From the Guidelines
The workup for a partially empty sella turcica (empty sella syndrome) typically involves an MRI of the sella turcica.
Initial Imaging
- MRI sella without and with IV contrast or MRI sella without IV contrast is usually appropriate for the initial imaging of adults with suspected or known pituitary gland abnormalities, including empty sella syndrome 1.
- The addition of IV contrast is preferred for the assessment of pituitary lesions; however, a noncontrast MRI also provides diagnostic detail 1.
Rationale
- An empty sella may be seen with herniation of the subarachnoid space into the sella turcica, and close to 30% of patients may demonstrate some hypopituitarism upon testing 1.
- MRI using high-resolution pituitary protocols is the preferred diagnostic imaging modality for evaluation of the pituitary and sellar regions, and can confirm absence or ectopia of the posterior pituitary gland 1.
- MRI with and without IV contrast plays an important role in characterizing lesions of the sella, suprasellar cistern, and any cavernous sinus invasion 1.
Key Points
- MRI is the best first-line test to evaluate the sella turcica and parasellar region 1.
- CT provides complementary information regarding bony anatomy, and may be appropriate as a first-line test in certain instances, but it provides less detail and lesion characterization when compared to MRI 1.
From the Research
Workup for Partially Empty Sella Turcica (Empty Sella Syndrome)
The workup for partially empty sella turcica, also known as empty sella syndrome, typically involves a combination of endocrine, ophthalmological, and neurological evaluations.
- Endocrine evaluation: This includes assessing pituitary function through tests such as thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels, as well as evaluating for other hormone deficiencies 2.
- Ophthalmological evaluation: A formal assessment of papilledema is recommended to rule out any ophthalmological symptoms 3.
- Neurological evaluation: This may include magnetic resonance imaging (MRI) of the brain to confirm the presence of an empty sella and to rule out any other underlying pathologies 2, 3.
- Additional tests: Depending on the patient's symptoms and medical history, additional tests such as growth hormone stimulation tests or other hormone level assessments may be necessary 4, 5.
Management and Referrals
The management of empty sella syndrome typically involves a multidisciplinary approach, with referrals to endocrinology, neurology, and ophthalmology as needed.
- Endocrine management: Replacement of hormone deficiencies is often necessary, and may involve medications such as thyroid hormone replacement or growth hormone therapy 4, 5.
- Neurological management: In some cases, surgical intervention may be necessary to relieve obstructive intracranial lesions or to treat other underlying neurological conditions 4.
- Ophthalmological management: Treatment of any ophthalmological symptoms, such as papilledema, may be necessary to prevent vision loss or other complications 3.