What is empty sella syndrome (ESS)?
Empty sella syndrome (ESS) is a rare condition in which your pituitary gland becomes flattened or shrinks due to issues with the contents within the sella turcica. The sella turcica is a bony structure at the base of your brain that surrounds and protects your pituitary gland.
The sella turcica is a saddle-like compartment. In Latin, it means “Turkish seat.” ESS causes certain symptoms, including hormonal imbalances, frequent headaches and vision changes.
Your pituitary gland is a small gland located at the base of your brain below your hypothalamus. It’s a part of your endocrine system and is in charge of making many different important hormones. These hormones affect and control other glands in your endocrine system.
What are the symptoms of empty sella syndrome (ESS)?
The most common symptom potentially associated with empty sella syndrome (ESS) is chronic headaches. However, researchers don’t know for sure if headaches develop because of ESS or are simply coincidental. Many people with ESS have high blood pressure (hypertension), which can itself cause headaches if it’s severe.
ESS usually causes hormonal imbalances due to damage to your pituitary gland. People with ESS may have different symptoms depending on which hormone(s) are affected. If you have ESS, you may have any of the following symptoms:
In rare cases, some people with empty sella syndrome have the following symptoms:
- Increased pressure within their skull (benign intracranial pressure).
- Leakage of cerebrospinal fluid from the nose (cerebrospinal rhinorrhea).
- Swelling of the optic disk due to increased cranial pressure (papilledema).
- Vision changes, such as loss of clarity of vision.
Again, you can have an empty sella appear on an imaging scan of your brain without having any symptoms. In fact, most people who have an empty sella don’t have symptoms and never develop symptoms.
Does empty sella syndrome (ESS) cause weight gain?
Empty sella syndrome (ESS) can potentially cause weight gain if your pituitary gland isn’t releasing enough thyroid-stimulating hormone (TSH).
TSH stimulates your thyroid — an endocrine gland that’s located in the front of your neck under your skin — to release thyroid hormone. Your thyroid’s main job is to release (secrete) thyroid hormones that control the speed of your metabolism (metabolic rate), which is the process of how your body transforms the food you consume into energy.
If your pituitary gland isn’t releasing enough TSH due to ESS, then your thyroid may not release enough thyroid hormone. Having lower-than-normal levels of thyroid hormone can slow down your metabolism, which can lead to weight gain.
What causes empty sella syndrome (ESS)?
Empty sella syndrome (ESS) can result from primary empty sella (PES) or secondary empty sella (SES), though it’s much more common to develop ESS from secondary empty sella.
Causes of primary empty sella syndrome (PES)
Primary empty sella (PES) happens when one of the layers (arachnoid) covering the outside of your brain bulges down into the sella turcica and presses on your pituitary gland.
Healthcare providers still don’t know the exact cause of primary empty sella syndrome.
One theory is that primary empty sella happens when a congenital defect in the tissue lining your brain creates the potential for cerebrospinal fluid to enter the sella turcica, flattening your pituitary gland. In these cases, the pituitary gland itself, while difficult to see on an imaging scan, is almost always functioning normally and doesn’t result in empty sella syndrome.
Causes of secondary empty sella (SES)
Secondary empty sella (SES) happens when your pituitary gland or the sella turcica is somehow damaged as a result of another condition or incident. For this reason, many things can cause SES. The general causes of damage include:
Some specific causes of secondary empty sella include:
- Brain tumors: Sometimes, brain tumors can cause increased pressure around your brain (intracranial pressure), which can lead to herniation of the subarachnoid space. This can lead to compression of your pituitary gland.
- Idiopathic intracranial hypertension (IIH): IIH is increased pressure in your skull that occurs because of cerebrospinal fluid (CSF) buildup around your brain. This extra pressure can lead to compression of your pituitary gland.
- Pituitary adenomas: A pituitary adenoma is a growth or tumor on your pituitary gland. They’re often noncancerous (benign). These adenomas can put pressure on your pituitary gland and damage it.
- Sheehan’s syndrome: Sheehan's syndrome is a condition that affects people who lose a life-threatening amount of blood during childbirth, which can deprive their bodies of oxygen. This lack of oxygen causes damage to their pituitary gland.
How is empty sella syndrome (ESS) treated?
If your healthcare provider found an empty sella on your imaging scans but your pituitary gland is functioning properly, you won’t need treatment. This is most often the case.
If your pituitary gland is not functioning properly due to empty sella syndrome (ESS), treatment typically involves medication that treats abnormal hormone levels, depending on which hormones are affected.
If ESS is causing cerebrospinal fluid to leak from your nose (CSF rhinorrhea), you may need surgery to repair your sella turcica.
How is empty sella syndrome (ESS) diagnosed?
In many cases, healthcare providers discover empty sella by chance (incidentally) when a person is undergoing head or brain imaging tests for another reason. And in most cases, people who have an empty sella don’t have or develop empty sella syndrome.
If you’re experiencing symptoms related to empty sella syndrome, such as frequent headaches and hormone imbalances, your provider will ask you about your medical history, perform a physical exam and will likely order an imaging procedure of your head and brain.
Imaging procedures that providers use to diagnose ESS include:
- A brain CT (computed tomography) scan: A brain CT scan uses X-rays and a computer to create detailed images of your brain and pituitary gland.
- A brain MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets to create detailed images of particular organs, tissues and structures inside your body, such as the sella turcica.
Your provider may order additional tests, such as blood tests, to check your hormone levels.
Sometimes, providers may perform tests to check for elevated pressure in your brain, including: