Empty Sella
Empty sella is an imaging finding in which the sella turcica—the small bony structure at the base of the skull that contains the pituitary gland—appears partially or completely filled with cerebrospinal fluid (CSF) instead of normal-appearing pituitary tissue. In most cases, the pituitary gland is still present but compressed and flattened along the floor of the sella. Empty sella is commonly discovered incidentally on brain imaging and often does not cause symptoms or affect hormone function. When associated with hormonal abnormalities or symptoms, it may be referred to as empty sella syndrome.
What is it?
The pituitary gland sits within the sella turcica, a saddle-shaped bony space located at the base of the skull. In empty sella, cerebrospinal fluid extends into this space and compresses the pituitary gland against the floor or walls of the sella. Despite the name, the sella is not truly empty because pituitary tissue is usually still present.
Empty sella is generally divided into two categories:
Primary empty sella occurs without a clearly identifiable pituitary disorder and is more commonly seen in middle-aged women. It is sometimes associated with obesity, high blood pressure, or idiopathic intracranial hypertension.
Secondary empty sella develops after a known pituitary-related event such as surgery, radiation therapy, pituitary tumor shrinkage, trauma, infection, or bleeding involving the pituitary gland.
MRI is the preferred imaging test for evaluating empty sella because it provides highly detailed views of the pituitary gland, cerebrospinal fluid spaces, and nearby structures such as the optic nerves and pituitary stalk. Dedicated pituitary MRI protocols with thin imaging slices and contrast enhancement can accurately demonstrate the flattened pituitary tissue and help exclude other abnormalities.
CT imaging may also show enlargement or remodeling of the sella but is generally less sensitive and specific than MRI for pituitary evaluation.
Important to Know
Most individuals with empty sella have normal pituitary hormone function and do not require treatment. In many cases, the finding is incidental and does not affect daily life or neurological function.
If hormonal abnormalities are detected, treatment may involve hormone replacement therapy under the guidance of an endocrinologist. Additional evaluation may also be recommended if symptoms such as headaches, visual changes, or signs of elevated intracranial pressure are present.
Follow-up imaging is not routinely required for asymptomatic cases but may be considered in select situations depending on symptoms, hormone testing results, or associated conditions.
Red flag symptoms include sudden severe headache, rapid vision changes, double vision, severe fatigue, fainting, low blood pressure, or symptoms suggesting pituitary hormone crisis. These symptoms require prompt medical evaluation.