Empty Sella Syndrome
Overview
Empty Sella syndrome (ESS ) is a very rare anatomical and treatable disorder that involves the Sella Turcica, a bony structure that protects the pituitary. Empty Sella Syndrome is a condition in which the pituitary gland, which is attached to the base of the brain, shrinks or becomes flattened.
The pituitary secretes hormones that regulate the body's balance of many hormones controlling growth, development, and metabolism of the body. This condition presents frequent headaches, hormone imbalances, and intolerance to stress and infection.
Unless the syndrome results in other medical issues, treatment is symptomatic as ESS is not a life-threatening condition.
Symptoms
Normally there are no symptoms or loss of pituitary function, but the condition may present the following -
• Erectile issues – are quite common. Often the problem goes away with little or no treatment.
• Headaches
• Irregular or absent menstruation
• Low-libido - Decreased or no desire for sex
• Low energy levels - fatigued
• Nipple discharge - Sometimes the discharge from the nipples is OK and will get better on its own.
But one may not need treatment if there are no symptoms, and if the pituitary gland is not enlarged
Causes & Risks
• Empty Sella syndrome can result from primary empty Sella. Primary empty Sella syndrome happens when one of the layers covering the outside of the brain bulges into Sella turcica and presses on the pituitary gland. No one knows 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
• A tumor and Radiation therapy could be one of the causes and risks.
• Any kind of Trauma and surgery
• 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 is increased pressure in your skull that occurs because of cerebrospinal fluid (CSF) built around the brain.
• 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 the pituitary gland.
Test & Diagnosis
Healthcare providers discover empty Sella by chance when a person is undergoing head or brain imaging tests for some other purpose...
• Primary empty Sella syndrome is most often discovered during an MRI or CT scan of the head and brain.
• The healthcare professional may order tests to check if the pituitary gland is working normally.
• Tests to check pressure in the brain will be done, such as -
-Retina examination by an ophthalmologist -Lumbar puncture.
-The healthcare provider withdraws cerebrospinal fluid. This test can detect meningitis, leukemia, and other illnesses. Professionals also use spinal taps to give spinal anesthesia and medications.
• The provider may order additional tests, such as blood tests, to check the hormone levels.
Treatment
For primary empty Sella syndrome:
• No treatment is needed if the pituitary function is normal. If your healthcare provider finds 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.
• Medicines might be prescribed to treat any abnormal hormone levels - If the 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.
• For secondary empty Sella syndrome, treatment involves replacing the hormones that are missing.
• In some cases, surgery is needed to repair the sella to prevent CSF from leaking into the nose and sinuses.
Living With
If an individual is diagnosed with empty sella syndrome and are experiencing new or worsening symptoms, contact the healthcare professional. If taking medicines to correct hormone imbalances due to empty sella syndrome, it’s important to see your provider regularly to make sure your medication is working.
Monitoring hormonal levels and overall health with the help of regular health check-ups is important. Endocrinologists oversee treatment to manage any hormonal imbalances.
Hormone replacement therapy may be necessary if the condition leads to deficiencies in hormone production. If a person experiences headaches or any kind of vision problems, the doctor will prescribe medicines to alleviate these symptoms.
Following Lifestyle Modifications - Eating a healthy and balanced diet, exercising regularly, managing stress, and ensuring adequate sleep can support the patient's overall well-being.
Complications
• Complications of primary empty sella syndrome include a slightly higher than normal level of prolactin. This is a hormone made by the pituitary gland. Prolactin stimulates breast development and milk production in women.
• Complications of secondary empty sella syndrome are related to the cause of pituitary gland disease or the effects of too little pituitary hormone (hypopituitarism).
• 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, known as the cerebrospinal rhinorrhoea, is another complication of empty sella syndrome. Swelling of the optic disk due to increased cranial pressure called papilledema
