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    Empty sella syndrome

    Empty sella syndrome is a condition in which the pituitary gland shrinks or becomes flattened.

    Causes

    The pituitary gland is a small gland located at the base of the brain. It sits in a saddle-like compartment in the skull called the "sella turcica," which in Latin means "Turkish saddle."

    When the pituitary gland shrinks or becomes flattened, it cannot be seen on MRI scans, making it look like an "empty sella." This is called empty sella syndrome.

    The pituitary makes several hormones that control the other glands in the body, including the:

    • Adrenal glands
    • Ovaries
    • Testicles
    • Thyroid

    Primary empty sella syndrome occurs when a hole in the membrane covering the pituitary gland allows fluid in, which presses on the pituitary.

    Secondary empty sella syndrome occurs when the sella is empty because the pituitary gland has been damaged by:

    • A tumor
    • Radiation therapy
    • Surgery

    Empty sella syndrome may be seen in a condition called pseudotumor cerebri, which mainly affects obese women.

    Symptoms

    Often, there are no symptoms or loss of pituitary function.

    Patients with empty sella syndrome may have symptoms caused by a partial or complete loss of pituitary gland function. For more information, see hypopituitarism.

    Symptoms include:

    • Erectile dysfunction (impotence)
    • Headaches
    • Irregular or absent menstruation
    • Low sexual desire (low libido)
    • Nipple discharge

    Exams and Tests

    Primary empty sella syndrome is most often discovered duringanMRI or CT scan.Pituitary function is usually normal.

    The health care provider may test the pituitary to make sure that the gland is working normally.

    Sometimes tests for high pressure in the brain will be done, such as:

    • Examination of the retina by an ophthalmologist
    • Lumbar puncture (spinal tap)

    The hormone prolactin is a little high in a small percentage of patients. This may interfere with the normal function of the testicles or ovaries.

    Treatment

    For primary empty sella syndrome:

    • There is no treatment if pituitary function is normal.
    • Medications such as bromocriptine, which lower prolactin levels, may be prescribed ifprolactin levels are high and interfering with thefunction of the ovaries or testes.

    For secondary empty sella syndrome:

    • Treatment involves replacing the hormones that are lacking.

    Outlook (Prognosis)

    Primary empty sella syndrome does not cause health problems, and it does not affect life expectancy.

    Possible Complications

    Complications of primary empty sella syndrome include mild hyperprolactinemia.

    Complications of secondary empty sella syndrome are related to the cause of pituitary gland disease or to the effects of too little pituitary hormone.

    When to Contact a Medical Professional

    Contact your health care provider if you develop symptoms of abnormal pituitary function, such as a disrupted menstrual cycle or impotence.

    References

    Melmed S, Kleinberg D, Ho Ken. Pituitary physiology and diagnostic evaluation. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 8.

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    • The pituitary gland

      illustration

      • The pituitary gland

        illustration

      A Closer Look

        Self Care

          Tests for Empty sella syndrome

            Review Date: 12/11/2011

            Reviewed By: Ari S. Eckman, MD, Division of Endocrinology and Nancy J. Rennert, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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