Available online 12 March 2024

Teaching Points:

Empty sella is a common incidental radiographic finding

Empty sella syndrome (ESS) is an empty sella finding with endocrine or neurologic abnormalities

All patients with empty sella should have clinical and hormonal evaluation to identify ESS

Isolated empty sella does not require treatment, but ESS may benefit from pharmacologic or surgical interventions

Treatment of ESS may involve multidisciplinary collaboration with endocrinology, neurology, neurosurgery, and/or ophthalmology

Incidental radiographic findings of an empty sella are prevalent in up to 35% of the general population. While empty sella was initially considered clinically insignificant, a subset of patients exhibits endocrine or neuro-ophthalmologic manifestations which are diagnostic of empty sella syndrome (ESS). Recent studies suggest that more patients are affected by ESS than previously recognized, necessitating a deeper understanding of this condition and an approach to evaluating and managing these patients. This comprehensive review addresses the etiologies and risk factors associated with primary and secondary empty sella, the radiological features that differentiate empty sella from other sellar lesions, and the role of clinical history and hormone testing in identifying patients with ESS. Pituitary function testing for somatotroph, lactotroph, gonadotroph, corticotroph, and thyrotroph abnormalities is necessary when suspecting this condition. While an isolated empty sella finding does not require treatment, ESS may require pharmacologic or surgical interventions to address hormone deficits or intracranial hypertension. Targeted hormone replacement as directed by the endocrinologist should align with guidelines and patient-specific needs. Treatment may involve a multidisciplinary collaboration with neurology, neurosurgery, or ophthalmology to address patient symptoms. This review underscores the evolving understanding of ESS, stressing the significance of accurate diagnosis and tailored management to mitigate potential neurologic and endocrine complications in affected individuals.

Empty sella

empty sella syndrome

pituitary

© 2024 Published by Elsevier Inc. on behalf of the AACE.