Empty Sella Syndrome (ESS) is when the pituitary gland flattens or narrows, making the sella turcica look empty. It can be caused by anatomical defects, pregnancy, or damage from surgery, head trauma, or radiation therapy. Primary ESS is typically asymptomatic, while secondary ESS may cause symptoms related to sexual organs and require hormone replacement therapy.
The sella turcica is a small depression in the sphenoid bone at the base of the skull. The pituitary gland sits atop this depression, with the sella turcica providing support and protection for the gland. In empty sella syndrome, or ESS, the pituitary gland has flattened or narrowed, which makes the sella turcica look empty. Empty Sella Syndrome occurs for a variety of reasons, including due to pituitary tumors or traumatic injury.
Empty saddle syndrome is classified into two different types: primary and secondary. In primary ESS, the cause of the syndrome is typically an anatomical defect that causes flattening of the pituitary gland on the surface of the sella turcica. One such defect is the result of a hole in the pituitary membrane. The hole allows excess fluid into the pituitary space, putting pressure on the gland and causing it to flatten. For women, pregnancy can be another cause. The pituitary gland can enlarge during pregnancy, but after delivery, it can shrink to less than its normal size. Also, the pituitary gland can shrink after menopause.
People with primary ESD are typically asymptomatic. Often, someone with the syndrome isn’t diagnosed unless they have a medical imaging test for an unrelated reason. People with the primary syndrome sometimes have high blood pressure or headaches, but these symptoms aren’t caused by the syndrome. Other possible symptoms include low libido, irregular menstruation in women and erectile dysfunction in men. People with this type of empty saddle syndrome generally don’t need treatment for the syndrome itself, but they may need treatment for associated conditions such as high blood pressure or sexual dysfunction.
In secondary ESD, the syndrome is the result of damage that causes the pituitary gland to shrink. Surgery, head trauma, or radiation therapy can cause damage to the pituitary gland that could lead to ESS. Alternatively, the syndrome may result from the growth of a tumor that invades the space occupied by the pituitary gland.
Hormones produced by the pituitary gland affect the sex organs, thyroid, and adrenal glands, so secondary ESD may be associated with defects in these organs. The symptoms of secondary empty saddle syndrome vary depending on the gender of the individual with the condition, due to the involvement of the sexual organs. Possible symptoms include infertility, low libido or sexual dysfunction, irregular or no periods, reduced tolerance to infections, and a lowered stress threshold. Treating secondary ESD symptoms involves treatment with synthetic hormones to replace the hormones that are missing.
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