Empty Sella Syndrome (ESS) Related to:

By SWA

The condition described involves the sella turcica, a bony structure at the base of the skull that houses the pituitary gland. When the sella turcica is filled with cerebrospinal fluid (CSF) and the pituitary gland is compressed against the bottom of this cavity, it is often referred to as Empty Sella Syndrome (ESS).

Cause of Empty Sella Syndrome:

Empty Sella Syndrome occurs when the sella turcica becomes filled with CSF, leading to the flattening or compression of the pituitary gland. The primary or secondary classification of ESS depends on its cause:

  1. Primary ESS: This occurs without an identifiable prior event and is often associated with a defect in the diaphragma sellae, the small membrane covering the sella turcica. This defect allows CSF to enter the sella, leading to increased pressure that compresses the pituitary gland. It may be associated with increased intracranial pressure or conditions such as idiopathic intracranial hypertension (IIH).

  2. Secondary ESS: This occurs due to a known factor that affects the pituitary gland, such as surgery, radiation therapy, pituitary tumor, infection, or head trauma. It can also result from pituitary gland shrinkage or injury.

Medical Consequences of Empty Sella Syndrome:

The compression of the pituitary gland can have various effects, depending on the degree of compression and the function of the gland:

  1. Hormonal Imbalances: The pituitary gland controls several hormones critical for bodily functions. Compression can lead to partial or complete hypopituitarism, causing deficiencies in hormones like:

    • ACTH: Can affect adrenal function, leading to fatigue, low blood pressure, and weakness.
    • TSH: Can result in hypothyroidism, causing weight gain, fatigue, and cold intolerance.
    • LH/FSH: May affect reproductive functions, causing irregular menstruation or infertility.
    • GH: Can lead to growth hormone deficiency, affecting growth in children or causing fatigue and changes in body composition in adults.
    • Prolactin: Altered levels can impact milk production in women and affect menstrual function.

  2. Visual Disturbances: Due to the proximity of the sella turcica to the optic chiasm, some patients may experience vision problems, such as double vision or visual field defects, though this is less common.

  3. Headaches: Patients with ESS often report chronic headaches, likely due to changes in intracranial pressure.

  4. Asymptomatic: In many cases, especially with primary ESS, patients may not experience any symptoms, and the condition is often found incidentally during imaging for other reasons.

  5. Neurological Symptoms: Rarely, patients may present with symptoms related to increased intracranial pressure, such as nausea, vomiting, or papilledema (swelling of the optic nerve).

Management:

  • Hormone Replacement: If hormonal deficiencies are detected, they can often be managed with appropriate hormone replacement therapy.
  • Monitoring: Regular follow-up and monitoring of pituitary function are essential, especially if symptoms develop or worsen.
  • Symptomatic Treatment: Treatment of headaches or visual disturbances as needed.
  • Surgical Intervention: Rarely indicated unless there are severe symptoms or associated conditions requiring it.

Empty Sella Syndrome is often benign, particularly in the absence of significant hormonal dysfunction, but it requires careful evaluation to manage any potential endocrine or neurological complications effectively.

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742

 

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