Empty Sella Syndrome

Ref:  Wilson: Williams Textbook of Endocrinology, 9th ed., 1998

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 floor.

An empty sella may occur as a result of:  

  1. 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.
  2. 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.