Empty sella syndrome

Empty sella syndrome (ESS) is a conditional name, in fact it is filled with cerebrospinal fluid (liquid washing the brain and spinal cord). Normally, almost all the Sella turcica occupies the anatomically located there pituitary gland. As a result of various pathological processes, the pituitary gland is reduced in size and is substituted by the cerebrospinal fluid.

To date, traditionally, there are two variants of the ESS – primary and secondary, which in turn are divided into complicated and uncomplicated variants.

Primary ESS develops either as a result of a congenital defect of the diaphragm of the Sella turcica and an increase in the liquor pressure (prolapse of the arachnoid membrane of the suprasellar cistern through the defect of the diaphragm of the Sella turcica). Or as a result of one of the options for the development of a primary empty sella as a result of physiological processes in women that change the size of the pituitary gland, such as pregnancy, menopause. During pregnancy, the size of the pituitary gland is approximately doubled. Moreover, in pluriparae, it is even larger, without returning to the original parameters. An additional predisposing factor is the multiple pregnancies ending in abortions. After the onset of menopause, the physiological involution of the pituitary gland occurs, it decreases in size and a free space is filled with liquor. A decrease in the pituitary is also possible due to the occurrence of Sheehan syndrome. Some researchers consider a theory suggesting the possible involvement of autoimmune reactions to pituitary cells, which lead to lymphocytic hypophysitis, and as a result – to pituitary atrophy.

Secondary ESS occurs after surgery (removal of a neoplasm in the chiasmal-sellar region), radiation, drug or combined treatment of diseases of the pituitary gland.

Uncomplicated ESS has no clinical pattern.

Symptoms of empty sell syndrome

Symptoms of complicated ESS may include cerebral symptoms such as headache, as well as arterial hypertension, impaired sexual function, obesity, arterial hypertension, visual impairment, etc.