From the Guidelines
A partially empty sella on a brain MRI is generally a benign finding that occurs when cerebrospinal fluid fills part of the pituitary fossa, causing the pituitary gland to appear flattened or smaller than normal. This condition is often discovered incidentally during imaging for unrelated reasons and typically doesn't require treatment. In most cases, a partially empty sella doesn't affect pituitary function, as noted in the study by 1. However, in some instances, it may be associated with hormonal imbalances if the pituitary tissue is significantly compressed. The condition can be primary (occurring spontaneously, more common in middle-aged, overweight women) or secondary (resulting from surgery, radiation, or pituitary tumor shrinkage).
Some key points to consider about a partially empty sella include:
- It is usually an incidental finding on MRI, as discussed in the study by 1
- It may be associated with hypopituitarism in some cases, as mentioned in the study by 1
- MRI is the preferred diagnostic imaging modality for evaluation of the pituitary and sellar regions, as stated in the study by 1
- Endocrine testing may be recommended to ensure pituitary hormones are functioning properly, especially if symptoms like fatigue, irregular periods, decreased libido, or other hormonal symptoms are present.
According to the study by 1, 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 hypofunctioning pituitary gland. The addition of IV contrast is preferred for the assessment of pituitary lesions; however, a noncontrast MRI also provides diagnostic detail. Most people with partially empty sella syndrome live normal lives without any intervention needed, but monitoring may be recommended in certain cases.
From the Research
Definition and Causes of Partially Empty Sella
- A partially empty sella is a condition where the pituitary gland becomes flattened or shrinks, leading to filling of the sella turcica with cerebrospinal fluid 2, 3.
- This condition can be caused by various factors, including the spontaneous resolution of a pituitary macroadenoma 3, brain tumors 4, or can be a normal variant in some individuals 5.
- The incidence of empty sella has been found to be higher in older patients and those with larger tumor volumes 4.
Clinical Significance of Partially Empty Sella
- The finding of a partially empty sella on routine MRI of the brain is usually of no clinical significance 5.
- However, in some cases, it can be associated with hypopituitarism, cerebrospinal fluid rhinorrhea, visual disturbance, and increased intracranial pressure 4.
- Endocrine function tests may be necessary to evaluate the clinical significance of a partially empty sella, especially if there are symptoms suggestive of a pituitary disorder 6.
Diagnosis and Evaluation
- Magnetic resonance imaging (MRI) is the primary diagnostic tool for evaluating a partially empty sella 2, 3, 4.
- Static and dynamic testing, as well as endocrine function tests, may be necessary to evaluate the clinical significance of a partially empty sella 3, 6.
- Careful review of brain MRI with periodic follow-up is necessary for the detection of secondary empty sella in patients with brain tumors 4.