Empty sella syndrome

A bony structure that surrounds the pituitary gland in order to protect it is known as sella turcica. Disorders involving this sella turcica is called empty sella syndrome. It occurs when the sella contracts or becomes crushed. Sella Turcica, which in latin stands for “Turkish saddle”, is a saddle like base where the pituitary gland resides. When the pituitary gland contracts or gets crushed, it can no longer be visible in MRI scans which is why it is known as the empty sella syndrome or ESS. Empty sella syndrome can be divided into two categories, primary ESS and secondary ESS.

Primary empty sella syndrome occurs when pituitary gland experiences pressure that crushes the Sella Turcica down and almost flattens it to the interior walls. This syndrome generally occurs in women with obesity or high blood pressure. It may lead to increase of fluid pressure in the skull which shrinks the pituitary gland.

Secondary empty sella syndrome happens when the wall around the pituitary gland contracts squishing the components due to an injury or radiation therapy. Patients who suffer from secondary ESS can have their pituitary gland severely damaged which harms the activities carried out by the pituitary gland and may cause disruption in menstrual periods, exhaustion, infertility and low tolerance level when it comes to stress and infections. Secondary ESS may also emerge among children after arriving at puberty, a shortage in growth hormones, tumors related to the pituitary gland etc. This can be detected through an MRI scan.

In both cases, there are some common symptoms that indicate empty sella syndrome. Headaches, an increase in bone density, odd facial features, problems in eyesight and short stature are some of the common symptoms that can work as a signal for ESS. It can only be detected by an MRI scan or radiological imaging of the brain. An examination of the retina carried out by an ophthalmologist may also help detect ESS. CT scannings are also helpful as it helps to identify any sort of hypodensity in an odd shaped sella turcica. Another way of investigating empty sella syndrome is by Angiograms, it helps to determine any sort of change in the sella turcica by examining any sort of transformation in the carotid artery. Even though it is a very complex syndrome, ESS is not life threatening.

There aren’t any necessary treatments that need to be carried out for both primary and secondary empty sella syndrome. However, in extreme cases, when it appears that the pituitary gland is getting tarnished progressively, surgery may be needed. The ongoing damage to the gland may cause permanent damage to the optic nerves as well as optic nerves and chiasm. Sometimes bromocriptine may be prescribed to decrease the prolactin levels which may disrupt the regular functions of ovaries or testicles.

The surgery that is carried out to improve the condition is called chiasmopexy. It can be performed by enhancing the optic chiasm by adding muscle, silicon sponge or carilage. To boost up the productivity of the pituitary gland, adding fat, muscles etc. through the tanssphenoidal route is usually carried upon. Congesting the sella with transsphenoidal placement of separable balloons is also another option. For secondary Empty Sella Syndrome, hormone replacement surgery may be necessary.

For primary empty sella syndrome, complications may lead to mediocre hyperprolactinemia. For secondary empty sella syndrome, several diseases might occur due to the lack of pituitary hormones.

Usually, empty sella syndrome is treated as a very mild non threatening condition. A lot of the cases have shown that ESS exists because of a degenerated pituitary tumor or as an aftermath of neurosarcoidosis. However in rare cases there have been evidences that showed co-existence of empty sella syndrome and pituitary tumors. Neurologists will assign several tests before deciding on the type of empty sella syndrome and how it should be treated. Hence, extreme headaches and sudden loss of visions should be immediately reported so that if it is possible Empty Sella Syndrome, it gets to be taken care of as soon as possible.

Last updated on Jul 18th, 2010 and filed under Endocrine System. Both comments and pings are currently closed.

Comments are closed