Empty sella syndrome occurs when the pituitary fossa appears partly or completely filled with cerebrospinal fluid on imaging, compressing the pituitary gland. Many people are asymptomatic, but hormonal and visual issues can arise.
Ocular and neurological aspects
Visual symptoms relate to chiasmal compression or associated raised pressure.
- Headache and sometimes visual field defects, typically bitemporal
- Possible papilloedema in idiopathic intracranial hypertension-related cases
- May be primary or secondary after pituitary surgery or infarction
- Hormonal disturbances such as hypopituitarism or hyperprolactinaemia
Management
Treatment is individualised based on symptoms.
- Endocrine evaluation and hormone replacement if needed
- Visual field monitoring and neuro-ophthalmology assessment
- Management of associated intracranial hypertension where present
- Neurosurgical input rarely required unless other lesions are identified
