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Empty Sella
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Empty sella (ES)
            • Definitions

              • Herniation of suprasellar arachnoid and cerebrospinal fluid (CSF) through wide diaphragma sellae into bony sella turcica
              • Sella turcica is partially filled with CSF
                • Rarely completely empty
                • Pituitary gland
                  • Almost never completely absent
                  • Thin, flattened rim of residual pituitary tissue
                  • Generally at posteroinferior sellar floor
              • Primary or secondary
                • Primary empty sella
                  • Common normal variant (15% of brain MRs), incidental finding
                  • Normal or increased CSF pressure
                  • Near-normal volume of compressed pituitary tissue
                  • No history of trauma, surgery, radiation
                  • Patients typically endocrinologically normal
                • Secondary empty sella
                  • Many etiologies
                    • Surgery
                    • Radiation
                    • Bromocriptine therapy
                    • Trauma
                    • Sheehan syndrome (postpartum pituitary necrosis)
                    • Pituitary apoplexy
                    • Pituitary abscess

            IMAGING

            • General Features

              • Imaging Recommendations

                • CT Findings

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Byrne N et al: Symptomatic primary tethered optic chiasm: Technical case report. Oper Neurosurg (Hagerstown). ePub, 2020
                                    2. Chen H et al: A case report of empty Sella syndrome secondary to Hantaan virus infection and review of the literature. Medicine (Baltimore). 99(14):e19734, 2020
                                    3. Guinto G et al: Osseous remodeling technique of the sella turcica: a new surgical option for primary empty sella syndrome. World Neurosurg. 126:e953-8, 2019
                                    4. Kirigin BiloŇ° LS et al: Empty sella in the making. World Neurosurg. 128:366-70, 2019
                                    5. Rehder D: Idiopathic intracranial hypertension: Review of clinical syndrome, imaging findings, and treatment. Curr Probl Diagn Radiol. ePub, 2019
                                    6. Seo YS et al: Bitemporal hemianopsia associated with empty sella syndrome. J Craniofac Surg. 30(8):2660-1, 2019
                                    7. Atci IB et al: Prognosis of hormonal deficits in empty sella syndrome using neuroimaging. Asian J Neurosurg. 13(3):737-41, 2018
                                    8. Auer MK et al: Primary empty sella syndrome and the prevalence of hormonal dysregulation. Dtsch Arztebl Int. 115(7):99-105, 2018
                                    9. Barzaghi LR et al: Treatment of empty sella associated with visual impairment: a systematic review of chiasmapexy techniques. Pituitary. 21(1):98-106, 2018
                                    10. Chiloiro S et al: Diagnosis of endocrine disease: Primary empty sella: A comprehensive review. Eur J Endocrinol. ePub, 2017
                                    11. Kyung SE et al: Enlargement of the sella turcica in pseudotumor cerebri. J Neurosurg. 120(2):538-42, 2014
                                    12. Saindane AM et al: Factors determining the clinical significance of an "empty" sella turcica. AJR Am J Roentgenol. 200(5):1125-31, 2013
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Empty sella (ES)
                                              • Definitions

                                                • Herniation of suprasellar arachnoid and cerebrospinal fluid (CSF) through wide diaphragma sellae into bony sella turcica
                                                • Sella turcica is partially filled with CSF
                                                  • Rarely completely empty
                                                  • Pituitary gland
                                                    • Almost never completely absent
                                                    • Thin, flattened rim of residual pituitary tissue
                                                    • Generally at posteroinferior sellar floor
                                                • Primary or secondary
                                                  • Primary empty sella
                                                    • Common normal variant (15% of brain MRs), incidental finding
                                                    • Normal or increased CSF pressure
                                                    • Near-normal volume of compressed pituitary tissue
                                                    • No history of trauma, surgery, radiation
                                                    • Patients typically endocrinologically normal
                                                  • Secondary empty sella
                                                    • Many etiologies
                                                      • Surgery
                                                      • Radiation
                                                      • Bromocriptine therapy
                                                      • Trauma
                                                      • Sheehan syndrome (postpartum pituitary necrosis)
                                                      • Pituitary apoplexy
                                                      • Pituitary abscess

                                              IMAGING

                                              • General Features

                                                • Imaging Recommendations

                                                  • CT Findings

                                                    • MR Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Byrne N et al: Symptomatic primary tethered optic chiasm: Technical case report. Oper Neurosurg (Hagerstown). ePub, 2020
                                                                      2. Chen H et al: A case report of empty Sella syndrome secondary to Hantaan virus infection and review of the literature. Medicine (Baltimore). 99(14):e19734, 2020
                                                                      3. Guinto G et al: Osseous remodeling technique of the sella turcica: a new surgical option for primary empty sella syndrome. World Neurosurg. 126:e953-8, 2019
                                                                      4. Kirigin BiloŇ° LS et al: Empty sella in the making. World Neurosurg. 128:366-70, 2019
                                                                      5. Rehder D: Idiopathic intracranial hypertension: Review of clinical syndrome, imaging findings, and treatment. Curr Probl Diagn Radiol. ePub, 2019
                                                                      6. Seo YS et al: Bitemporal hemianopsia associated with empty sella syndrome. J Craniofac Surg. 30(8):2660-1, 2019
                                                                      7. Atci IB et al: Prognosis of hormonal deficits in empty sella syndrome using neuroimaging. Asian J Neurosurg. 13(3):737-41, 2018
                                                                      8. Auer MK et al: Primary empty sella syndrome and the prevalence of hormonal dysregulation. Dtsch Arztebl Int. 115(7):99-105, 2018
                                                                      9. Barzaghi LR et al: Treatment of empty sella associated with visual impairment: a systematic review of chiasmapexy techniques. Pituitary. 21(1):98-106, 2018
                                                                      10. Chiloiro S et al: Diagnosis of endocrine disease: Primary empty sella: A comprehensive review. Eur J Endocrinol. ePub, 2017
                                                                      11. Kyung SE et al: Enlargement of the sella turcica in pseudotumor cerebri. J Neurosurg. 120(2):538-42, 2014
                                                                      12. Saindane AM et al: Factors determining the clinical significance of an "empty" sella turcica. AJR Am J Roentgenol. 200(5):1125-31, 2013