Empty Sella Syndrome (ESS)
- Article
- 2021-03-09
Empty Sella Syndrome (ESS) is a condition involving the sella turcica , a bony structure at the base of the brain that surrounds and protects the pituitary gland. ESS is often discovered during radiological imaging tests for pituitary gland conditions. ESS occurs in up to 25 percent of the population. A person with ESS may not have or may have symptoms that result from partial or complete loss of pituitary function (including headache, low sex drive, and impotence). There are two types of ESS: primary and secondary. Primary ESS happens when a small anatomical defect above the pituitary gland causes spinal fluid to partially or completely fill the sella turcica. This flattens the gland along the inner walls of the sella turcica cavity. Individuals with primary ESS may have high levels of the hormone prolactin, which can interfere with the normal function of the testicles and ovaries. Primary ESS is most common in adults and women and is often associated with obesity and high blood pressure. In some cases the pituitary gland may be smaller than normal; this may be due to a condition called pseudotumor cerebri (meaning 'false brain tumor' caused by high pressure in the skull). In rare cases, this high fluid pressure can be associated with the discharge of spinal fluid through the nose. Secondary ESS is the result of a deterioration of the pituitary gland in the cavity after injury, surgery, or radiation therapy. Individuals with secondary ESS may sometimes have symptoms that reflect loss of pituitary function, such as cessation of menstruation, infertility, fatigue, and intolerance to stress and infection. In children, ESS may be associated with early onset of puberty, growth hormone deficiency, pituitary tumors or pituitary dysfunction. Magnetic Resonance Imaging (MRI) scans are useful in evaluating ESS and identifying underlying conditions that may be the cause of high fluid pressure.
Therapy
Unless the syndrome results in other medical problems, the treatment of endocrine dysfunction associated with pituitary disorders is symptomatic and supportive. Individuals with primary ESS who have high prolactin levels can receive bromocriptine. In some cases, especially when spinal fluid drainage is observed, surgery may be required.
Prognosis
ESS is not a life-threatening condition. Most of the time, and especially in those with primary ESS, the condition does not cause health problems and does not affect life expectancy.
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