Empty Sella Syndrome
Ref: Wilson: Williams Textbook of Endocrinology, 9th ed.,
An empty sella is usually an incidental anatomic finding that results
in abnormal pituitary function in occasional patients. Pituitary fossa
enlargement is a result of a communicating extension of the subarachnoid
space into the pituitary fossa, which promotes remodeling and enlargement
of the bony sella and flattening of the pituitary gland against the sella
An empty sella may occur as a result of:
Primary empty sella - a congenital diaphragmatic defect
This is a fairly common incidental finding and is usually associated with
only minor disturbances of pituitary function.
Mild hyperprolactinemia (usually <100 mug/L, with or without
galactorrhea) occurs in approximately 15% of patients. Since even a mild
elevation of prolactin may interfere with normal gonadal function, this may
require treatment, but the patient should be reassured that this problem
does not usually result in additional pituitary dysfunction.
Secondary empty sella - as a result of damage to the diaphragm by
surgery, radiotherapy, or pituitary tumor infarction.
If the empty sella is associated with destruction of the pituitary gland,
complete or partial hypopituitarism is the outcome.
Measurement of serum pituitary and target organ hormones is necessary to
establish the diagnosis of hormone deficiency and to determine the central
(hypothalamic or pituitary) cause of the dysfunction (e.g., serum thyrotropin
and T4 ; corticotropin, cortisol; LH and testosterone).
Children with an empty sella most commonly have GH deficiency, although other
pituitary hormone dysfunction may occur. In children with isolated GH deficiency
or multiple pituitary deficiencies, empty sella was observed in 48% but was
present in only 2% of children with normal pituitary function.