Empty sella syndrome
|Empty sella syndrome|
|Other names||Pituitary - empty sella syndrome|
|MRI of Empty Sella|
|Causes||Arachnoid presses down on gland (another possibility is a Tumor, Radiation therapy)|
|Diagnostic method||MRI, CT scan|
|Medication||Manage abnormal hormone levels|
Empty sella syndrome (ESS) is the condition when the pituitary gland shrinks or becomes flattened, filling the sella turcica with cerebrospinal fluid instead of the normal pituitary. ESS can be found in the diagnostic workup of pituitary disorders, or as an incidental finding when imaging the brain.
Signs and symptoms
If there are symptoms, people with empty sella syndrome can have headaches and vision loss. Additional symptoms would be associated with hypopituitarism. Additional symptoms are as follows:
- Abnormality (middle ear ossicles)
- Arnold-Chiari type I malformation
- Patent ductus arteriosus
- Muscular hypotonia
The cause of this condition is divided into primary and secondary, as follows:
- The cause of this condition in terms of secondary empty sella syndrome happens when a tumor or surgery damages the gland, this is an acquired manner of the condition.
- ~70% of patients with Idiopathic intracranial hypertension will have empty sella on MRI
- The cause of primary empty sella syndrome is a congenital defect (diaphragma sellae)
The normal mechanism of the pituitary gland sees that it controls the hormonal system, which therefore has an effect on growth, sexual development, and adrenocortical function. The gland is divided into anterior and posterior.
There are two types of ESS: primary and secondary.
- Primary ESS happens when a small anatomical defect above the pituitary gland increases pressure in the sella turcica and causes the gland to flatten out along the interior walls of the sella turcica cavity. Primary ESS is associated with obesity and increase in intracranial pressure in women.In most cases, especially in people with primary ESS, there are no symptoms and it does not affect life expectancy. Some researchers have estimated that less than 1% of affected people ever develop symptoms of the condition.
- Secondary ESS is the result of the pituitary gland regressing within the cavity after an injury, surgery, or radiation therapy. Individuals with secondary ESS due to destruction of the pituitary gland have symptoms that reflect the loss of pituitary functions, such as intolerance to stress and infection.[medical citation needed]
The major differential to consider in empty sella syndrome is intracranial hypertension, of both unknown and secondary causes, and an epidermoid cyst, which can mimic cerebrospinal fluid due to its low density on CT scans, although MRI can usually distinguish the latter diagnosis.
In terms of management, unless the syndrome results in other medical problems, treatment for endocrine dysfunction associated with pituitary malfunction is symptomatic and thus supportive; however, surgery may be needed in some cases.
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