Empty sella syndrome is the apperance, by a radiograph, that shows the sella turcica which usually houses the pituritaty gland, empty! After making a statement like this, one might ask how can a human function without the presence of the body's most important endocrine gland. After all, it only plays a major role in regulating the body's entire endocrine system by producing secretions that controls other endocrine glands that influence growth, metabolism and maturation. I don't mean to harp on this but the pituitary gland plays a part in every physiolocial process in the body. However, there is a reason for everything and the empty space is not always truly empty.
In Primary ESS, the voided appearance is a result of CSF that has entered the space normally occupied by the pituitary and has compressed the hypophysis against the wall of the sella turcica. Secondary ESS is the result of the pituitary gland regressing within the cavity after an injury, surgery or radiation therapy. Disease or tramua may reduce the size of the pituitary or completly eliminate it! Statistics from autopsies show that 5% to 25% empty sellar syndrome is found incidentally.
Causes and Symptoms
There are no known triggers or causative factors that relates to Primary ESS. Because of the unknown etiologic factors it is thought to be a congenital and accidental occurence by a failure or opening of the diaphragma sella. Secondary ESS is an acquired cause through a medical procedure, disease or truama. All of these reasons can contribute to the reduction in size or a complete absence of the gland. Sheehan's syndrome, is a specific type of acquired empty sellar syndrome, that is caused by infarction of the pituitary induced by shock or hemorrhage after labor and delivery.
Primary ESS: symptoms are usually associated with obesity and high blood pressure in women.
Secondary ESS: the condition is a byproduct of some other process leading to destruction and loss of pituitary functions, such as the ceasing of mestrual periods, inpotence, infertility, fatigue and an intolerance to stress and infection.
TREATMENT
Replacement therapy for any deficient hormone. All treatment would be symptomatic and supportive.
DIAGNOSIS
Empty sella syndrome is always diagnosed by some type of imaging study of the brain (x-ray, ct or mr)
PROGNOSIS
ESS is not a life-threatening illness but is a lifelong illness.
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