Empty sella syndrome (ESS) is a rare and treatable condition that happens when your pituitary gland becomes flattened. ESS causes certain symptoms such as frequent headaches and hormone imbalances.
Empty sella syndrome (ESS) is a rare condition in which your pituitary gland becomes flattened or shrinks due to issues with the contents within the sella turcica. The sella turcica is a bony structure at the base of your brain that surrounds and protects your pituitary gland.
The sella turcica is a saddle-like compartment. In Latin, it means “Turkish seat.” ESS causes certain symptoms, including hormonal imbalances, frequent headaches and vision changes.
Your pituitary gland is a small gland located at the base of your brain below your hypothalamus. It’s a part of your endocrine system and is in charge of making many different important hormones. These hormones affect and control other glands in your endocrine system.
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Some information sources use “empty sella syndrome” and “empty sella” interchangeably, but they’re slightly different. In short, empty sella is a radiological finding and empty sella syndrome is a condition.
Empty sella is a radiological finding of a flattened pituitary gland. When your pituitary gland shrinks or becomes flattened, your healthcare provider can’t see it on imaging scans. This makes the area of the pituitary gland — the sella turcica — look empty, hence the name “empty sella.”
However, the sella turcica isn’t actually empty. It’s often filled with cerebrospinal fluid (CSF). CSF is fluid that surrounds your brain and spinal cord. With empty sella, CSF has leaked into the sella turcica, which puts pressure on your pituitary gland. This causes the gland to shrink or flatten.
Often, healthcare providers discover empty sellas by chance (incidentally) on a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan when people are being evaluated for other reasons.
People can have an empty sella on their imaging results without having any symptoms — their pituitary gland functions as it should.
If someone has an empty sella and their pituitary gland isn’t functioning properly, it’s called empty sella syndrome (ESS). A syndrome is a set of medical signs and symptoms that are correlated with each other and often associated with a particular condition. People with ESS can experience hormonal imbalances, vision changes and frequent headaches.
When your healthcare provider identifies an empty sella on your imaging scans, they categorize it as one of two types: primary or secondary.
Primary empty sella (PES) means that your provider can’t identify the underlying cause of your flattened pituitary gland. Primary empty sella doesn’t usually cause empty sella syndrome. In other words, it doesn’t usually cause symptoms.
Secondary empty sella (SES) is caused by an identifiable underlying condition that changes the anatomy of your pituitary gland and/or the sella turcica. This is usually due to some kind of damage as a result of a condition or incident.
Secondary empty sella (SES) more often leads to empty sella syndrome than PES.
Empty sella syndrome (ESS) isn't life-threatening. It’s treatable with hormone medications and sometimes surgery.
Having an empty sella show up on your brain imaging scan is also not life-threatening. Most cases of empty sella don't lead to empty sella syndrome or any symptoms.
Your pituitary gland is an important endocrine gland that’s in charge of making many different hormones. It also tells other endocrine system glands to release hormones, including your:
Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, muscles and other tissues. These signals tell your body what to do and when to do it.
Your pituitary gland is connected to your hypothalamus through a stalk of blood vessels and nerves. This is called the pituitary stalk. Through the stalk, your hypothalamus communicates with your pituitary gland and tells it to release certain hormones. Your hypothalamus is the part of your brain that controls functions like blood pressure, heart rate, body temperature and digestion.
Your pituitary gland makes the following hormones:
Your pituitary gland doesn’t produce and release all of these hormones continuously. Most are released in bursts every one to three hours.
Though it’s rare, both children and adults can develop empty sella syndrome (ESS).
People assigned female at birth (AFAB) are four times more likely to have primary empty sella (PES) — not necessarily empty sella syndrome — than people assigned male at birth (AMAB).
PES most commonly occurs between the ages of 30 and 40 years old. It sometimes develops earlier in people AFAB than people AMAB.
People AFAB are even more likely to have PES if they’ve had a full-term pregnancy.
PES occurs less frequently in children than in adults. In these cases, it’s often associated with other conditions, including:
Empty sella syndrome (ESS) is rare. Some researchers have estimated that less than 1% of people with an empty sella develop symptoms (develop empty sella syndrome).
Having an empty sella without symptoms is much more common. Reports estimate that 8% to 35% of the population have an empty sella. Based on results from neuroimaging testing, other reports estimate that empty sella occurs in 12% of people.
The most common symptom potentially associated with empty sella syndrome (ESS) is chronic headaches. However, researchers don’t know for sure if headaches develop because of ESS or are simply coincidental. Many people with ESS have high blood pressure (hypertension), which can itself cause headaches if it’s severe.
ESS usually causes hormonal imbalances due to damage to your pituitary gland. People with ESS may have different symptoms depending on which hormone(s) are affected. If you have ESS, you may have any of the following symptoms:
In rare cases, some people with empty sella syndrome have the following symptoms:
Again, you can have an empty sella appear on an imaging scan of your brain without having any symptoms. In fact, most people who have an empty sella don’t have symptoms and never develop symptoms.
Empty sella syndrome (ESS) can potentially cause weight gain if your pituitary gland isn’t releasing enough thyroid-stimulating hormone (TSH).
TSH stimulates your thyroid — an endocrine gland that’s located in the front of your neck under your skin — to release thyroid hormone. Your thyroid’s main job is to release (secrete) thyroid hormones that control the speed of your metabolism (metabolic rate), which is the process of how your body transforms the food you consume into energy.
If your pituitary gland isn’t releasing enough TSH due to ESS, then your thyroid may not release enough thyroid hormone. Having lower-than-normal levels of thyroid hormone can slow down your metabolism, which can lead to weight gain.
Empty sella syndrome (ESS) can result from primary empty sella (PES) or secondary empty sella (SES), though it’s much more common to develop ESS from secondary empty sella.
Primary empty sella (PES) happens when one of the layers (arachnoid) covering the outside of your brain bulges down into the sella turcica and presses on your pituitary gland.
Healthcare providers still don’t know the exact cause of primary empty sella syndrome.
One theory is that primary empty sella happens when a congenital defect in the tissue lining your brain creates the potential for cerebrospinal fluid to enter the sella turcica, flattening your pituitary gland. In these cases, the pituitary gland itself, while difficult to see on an imaging scan, is almost always functioning normally and doesn’t result in empty sella syndrome.
Secondary empty sella (SES) happens when your pituitary gland or the sella turcica is somehow damaged as a result of another condition or incident. For this reason, many things can cause SES. The general causes of damage include:
Some specific causes of secondary empty sella include:
In many cases, healthcare providers discover empty sella by chance (incidentally) when a person is undergoing head or brain imaging tests for another reason. And in most cases, people who have an empty sella don’t have or develop empty sella syndrome.
If you’re experiencing symptoms related to empty sella syndrome, such as frequent headaches and hormone imbalances, your provider will ask you about your medical history, perform a physical exam and will likely order an imaging procedure of your head and brain.
Imaging procedures that providers use to diagnose ESS include:
Your provider may order additional tests, such as blood tests, to check your hormone levels.
Sometimes, providers may perform tests to check for elevated pressure in your brain, including:
If your healthcare provider found an empty sella on your imaging scans but your pituitary gland is functioning properly, you won’t need treatment. This is most often the case.
If your pituitary gland is not functioning properly due to empty sella syndrome (ESS), treatment typically involves medication that treats abnormal hormone levels, depending on which hormones are affected.
If ESS is causing cerebrospinal fluid to leak from your nose (CSF rhinorrhea), you may need surgery to repair your sella turcica.
Healthcare providers aren’t sure what causes some people with an empty sella to develop empty sella syndrome. However, you’re more likely to develop empty sella syndrome from secondary empty sella than primary empty sella.
The outlook (prognosis) for empty sella syndrome (ESS) is generally good. Medications are available to treat hormonal imbalances. If you have hormonal imbalances from ESS, you may have to take medication for the rest of your life.
If you’ve been diagnosed with empty sella syndrome and are experiencing new or worsening symptoms, contact your healthcare provider.
If you take medication to correct hormone imbalances due to empty sella syndrome, it’s important to see your provider regularly to make sure your medication is working properly.
A note from Cleveland Clinic
Empty sella syndrome is a very rare condition. However, finding out you have an empty sella from imaging procedures of your brain is fairly common. There’s no need to worry if your healthcare provider tells you this. The vast majority of people with an empty sella don’t develop empty sella syndrome. If you have any questions about your imaging results, don’t be afraid to ask your provider questions. They’re available to help.
Last reviewed by a Cleveland Clinic medical professional on 05/26/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy