The empty sella syndrome refers to the gross or radiographic appearance, with no apparent pituitary tissue seen in the sella turcica (it looks empty). There may be a real loss of pituitary tissue or the pituitary may have been compressed against the sides of the sella.


Mechanisms of the empty sella:

(1) compression of the pituitary gland by an arachnoid diverticulum (an intrasellar arachnoidocele)

(2) atrophy/destruction of the pituitary gland


Causes of an arachnoid diverticulum:

(1) congenital (primary) defect in the sellar diaphragm

(2) acquired defect in the sellar diaphragm (associated with benign intracranial hypertension, radiation, surgery)


Causes of pituitary gland atrophy/destruction:

(1) infarction

(2) radiation

(3) pituitary surgery


Clinical findings:

(1) normal pituitary function or hypopituitarism

(2) visual field defects (if the optic chiasm prolapses downwards)

(3) hyperprolactinemia due to traction on the pituitary stalk


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