Learn About Empty Sella Syndrome
Empty sella syndrome is a condition in which the pituitary gland shrinks or becomes flattened.
Pituitary - empty sella syndrome; Partial empty sella
The pituitary is a small gland located just underneath the brain. It is attached to the bottom of the brain by the pituitary stalk. The pituitary sits protected inside a saddle-like bony compartment in the base of the skull. This compartment is called the sella turcica, but often just called the sella.
When the pituitary gland shrinks or becomes flattened, it cannot be seen on an MRI scan. This makes the area of the pituitary gland look like an empty sella. But the sella is not actually empty. It is often filled with cerebrospinal fluid (CSF). CSF is fluid that surrounds the brain and spinal cord. With empty sella syndrome, CSF has leaked into the sella turcica, putting pressure on the pituitary. This causes the gland to shrink or flatten.
Primary empty sella syndrome occurs when one of the layers (arachnoid) covering the outside of the brain bulges down into the sella and 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
- Trauma
Empty sella syndrome may be seen in a condition called pseudotumor cerebri, which mainly affects young, obese women and causes the CSF to be under higher pressure.
The pituitary gland makes several hormones that regulate other glands and hormones in the body, including:
- Adrenal glands
- Liver hormone related to growth (insulin-like growth factor-1)
- Ovaries
- Testicles
- Thyroid
A problem with the pituitary gland can lead to problems with any of the above glands and abnormal hormone levels of these glands.
Often, there are no symptoms or loss of pituitary function.
If there are symptoms, they may include any of the following:
- Erection problems
- Headaches
- Irregular or absent menstruation
- Decreased or no desire for sex (low libido)
- Fatigue, low energy
- Nipple discharge
For primary empty sella syndrome:
- No treatment is needed if pituitary function is normal.
- Medicines may be prescribed to treat any abnormal hormone levels.
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.
Duke Cancer Center
Patrick Codd is a Neurosurgery provider in Durham, North Carolina. Dr. Codd is rated as an Advanced provider by MediFind in the treatment of Empty Sella Syndrome. His top areas of expertise are Prolactinoma, Pituitary Tumor, Encephalocele, Awake Craniotomy, and Mastoidectomy. Dr. Codd is currently accepting new patients.
Swedish Neurosurgery - Cherry Hill
Dr. Litvack values a collaborative multi-disciplinary approach to caring for patients suffering from benign or malignant brain tumors, head and neck cancers involving the brain and spine, chronic pain and degenerative spinal disorders. Dr. Litvack applies his unique expertise in skull base surgery, neuroendoscopy, minimally invasive cranial, and minimally invasive spinal surgery to restore patients to health while minimizing the physical and emotional impact of surgery. His patients benefit from being fully informed of their disease and their treatment options. Dr. Litvack and his patients also benefit from 24/7 access to a team of fellowship-trained physicians and surgeons with extensive experience in Neurosurgery, Otolaryngology, Neuroanesthesia, Neuro-endocrinology, Neuro-ophthalmology, Neuro-Oncology and Radiation Oncology. Dr. Litvack has also been selected by Seattle Magazine and Seattle Metropolitan Magazine as a Top Doctor in the field of Neurosurgery. Dr. Litvack is rated as an Advanced provider by MediFind in the treatment of Empty Sella Syndrome. His top areas of expertise are Pituitary Tumor, Prolactinoma, Hypothalamic Tumor, Balloon Sinuplasty, and Awake Craniotomy.
Sabrina Chiloiro practices in Rome, Italy. Ms. Chiloiro is rated as an Elite expert by MediFind in the treatment of Empty Sella Syndrome. Her top areas of expertise are Acromegaly, Hypertrichosis-Acromegaloid Facial Appearance Syndrome, Acromegaloid Facial Appearance Syndrome, Hormone Replacement Therapy (HRT), and Orchiectomy.
Primary empty sella syndrome does not cause health problems, and it does not affect life expectancy.
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 to the effects of too little pituitary hormone (hypopituitarism).
Contact your provider if you develop symptoms of abnormal pituitary function, such as menstrual cycle problems or impotence.
Published Date: April 24, 2025
Published By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Kaiser U, Ho KKY. Pituitary physiology and diagnostic evaluation. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 6.
Weiss RE. Anterior pituitary. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 205.