In empty sella syndrome (empty stella syndrome), the pituitary gland, which is located in the stella turcica, is not visible. The reasons are of different nature. As a rule, those affected have no complaints. Whether and what treatment is required depends on the reason why empty sella syndrome has occurred.
What is empty sella syndrome?
If the pituitary gland is not visible in the Stelle turcica, or Turk’s saddle, on magnetic resonance imaging or computed tomography scans, physicians refer to it as Empty Sella syndrome. Predominantly, an outpouching of the meninges is responsible; that outpouching ensures that the pituitary gland cannot be detected. This does not mean that the pituitary gland is not present; it is simply not visible. Usually, no symptoms occur; however, if the patient complains of headaches, visual disturbances, or a recurrent runny nose, treatment is required.
Causes
The so-called empty sella syndrome occurs predominantly in women who are in their middle years, suffer from hypertension, and are overweight. Such circumstances are therefore repeatedly referred to as risk factors. Only rarely does Empty Sella Syndrome occur after radiation, infarction or surgery. Physicians assume that sometimes a hormone imbalance, which has already arisen in early puberty, is responsible for the Empty Sella Syndrome. To date, however, there is no 100 percent explanation as to why empty sella syndrome actually occurs.
Symptoms, complaints, and signs
Often, affected individuals have no symptoms at all. If empty sella syndrome is diagnosed even though no symptoms are present, it is usually an incidental diagnosis. This circumstance occurs when the patient – due to other complaints – is examined by magnetic resonance imaging or computer tomography. Only rarely do patients suffer from headaches, a constant running nose (leakage of cerebrospinal fluid) and visual disturbances. If symptoms suggestive of Empty Sella Syndrome occur, the physician recommends treatment of the syndrome – based on the cause. However, if the patient is symptom-free, no treatments are given.
Diagnosis and course
As a rule, Empty Sella syndrome is diagnosed only by chance. However, if there is a suspicion – because the patient has multiple complaints – that suggest Empty Sella syndrome, a computed tomography or magnetic resonance imaging scan is performed. If the physician does not discover any pituitary gland, he can assume that it is the so-called Empty Sella Syndrome. If there are no symptoms, he can dispense with other examinations. However, it is important that those affected have themselves examined – at regular intervals – so that any changes, if they occur, can be detected in good time. The course of the disease depends on the circumstance of the cause. If there is an outpouching of the meninges, whereby the pituitary gland is not affected in its function, the life expectancy of the patient remains unchanged. However, if there is an excess of prolactin or sometimes an underfunction of the pituitary gland, only then the life expectancy remains unchanged. However, this is accompanied by medication to regulate the prolactin excess. If there is no treatment, the life expectancy is ten, maximum 15 years. As a rule, however, Empty Sella Syndrome progresses without symptoms or complications.
When should you see a doctor?
In most cases, empty sella syndrome does not require treatment. However, if symptoms develop, it is best to talk to your primary care physician. A frequent runny nose, visual disturbances, and headaches are typical symptoms that require medical evaluation. If the neurologist determines an excess of prolactin or an underactivity of the pituitary gland, treatment is required. Because the medications typically prescribed are associated with side effects and drug interactions, close consultation with the physician should be maintained during therapy. After treatment is complete, regular check-ups are indicated, otherwise the original symptoms may recur, sometimes causing serious complications. Empty sella syndrome predominantly affects women who are overweight, have high blood pressure or are approaching menopause.It also occurs more frequently after radiation, infarctions or operations. Patients at risk should talk to their doctor if they have any of these symptoms. If symptoms are severe, it may be advisable to call in the emergency medical service or go directly to the nearest hospital.
Treatment and therapy
Before deciding on treatment, the medical professional must determine in advance the cause of why empty sella syndrome occurred in the first place. If there are no symptoms, no treatment is necessary. It is important that patients nevertheless visit the doctor – at regular intervals – to have any check-ups performed. If changes occur, the doctor can react quickly. If a disease exists that is subsequently responsible for the Empty Sella Syndrome, it is not the resulting symptom – i.e. the Empty Sella Syndrome – that should be treated, but the underlying disease. In this case, depending on the underlying disease, various therapies and treatments are available. If the patient complains of headaches, a permanently runny nose or visual disturbances, the symptoms can be alleviated by minor interventions. In this case, the physician takes care of the bulging meninges, filling the sella with very small pieces of bone. In this way, the meninges can no longer bulge out, so that the pituitary gland has sufficient space and the symptoms are therefore alleviated. If there is an excess of prolactin, which is subsequently responsible for the Empty Sella Syndrome, the pituitary gland can be supported with various medications. These belong to the category of dopamine agonists. There is an automatic reduction in prolactin production. It should be noted that dopamine agonists are drugs that have a similar effect to dopamine. This is a neurotransmitter that stimulates the nervous system and hypothalamus to inhibit the production of prolactin. In this way, an excess of prolactin can subsequently be prevented. If there is an underactivity of the pituitary gland, it is important that the missing hormones are subsequently replaced by medication. If the physician diagnoses a deficiency of growth hormones, he must therefore administer the corresponding growth hormones – by injection. In the case of an ACHTH deficiency, glucocorticoids are administered, but in the form of cortisone. If there is a deficiency of thyroid hormone, tablets are administered. As a rule, hormones are administered for life. The only exception is growth hormones; those are given only until adolescent age.
Outlook and prognosis
In many cases, hormone replacement is sufficient for this acquired endocrinologic disorder. This can provide good treatment for any symptoms that may occur. However, diagnosis of the syndrome is usually incidental. This can be a problem. Many of those affected do not experience any symptoms as a result of the Empty Sella syndrome. For these patients, the prognosis is good. Although the pituitary gland is not visible on imaging, there does not appear to be any loss of function or dysfunction in many affected individuals. The outlook is somewhat worse if typical symptoms develop as a result of empty sella syndrome. These may include headaches, a runny nose due to leakage of cerebrospinal fluid from the brain, or visual disturbances. If a prolactin excess is also diagnosed, this should be balanced. If this is not done because the acquired syndrome is not detected, the expectation of survival is reduced to about 15 years after the onset of the Empty Sella syndrome. Occasionally, in addition to Empty Sella syndrome, hypofunction of the pituitary gland is detected. This disorder can be regulated by means of tablets. The life expectancy of affected individuals is not limited with proper treatment. Whether hypofunction of the pituitary gland is the cause or effect of Empty Sella syndrome is currently unknown. The prognosis is positive, provided the patient is closely monitored medically. This is because of the potential side effects of therapy.
Prevention
Empty sella syndrome cannot be prevented. Risk factors, such as obesity or high blood pressure, do favor empty sella syndrome, although physicians are uncertain whether – if the risk factors are eliminated – the syndrome can actually be prevented.
Aftercare
In the case of Empty Sella syndrome, the patient has very few options for aftercare. Here, first and foremost, the disease must be treated if symptoms occur in everyday life. Furthermore, the recognition of the underlying disease is usually very important to prevent the recurrence of the Empty Sella Syndrome. If the syndrome does not lead to any further complaints or complications in the daily life of the affected person, no treatment needs to be carried out, whereby the possibilities for follow-up care are also eliminated in this case. In some cases, the affected person has to undergo a surgical intervention to alleviate the discomfort of the syndrome. After this procedure, the affected person must always rest and take care of the body. Efforts or stressful activities should therefore always be avoided in order to speed up the healing process. Likewise, care by one’s own family or by friends and relatives has a positive effect on the course of this disease. Furthermore, in some cases patients are dependent on taking medication. It is important to ensure that the medication is taken regularly and correctly, and in cases of doubt a doctor should always be consulted. The life expectancy of the affected person is not reduced by Empty Sella syndrome.
What you can do yourself
Patients can do much to prevent Empty Sella syndrome as well as improve their well-being. In particular, they should pay attention to maintaining their normal weight. An increase in their own weight can be prevented with a healthy and balanced diet as well as sufficient exercise. Without further help or recourse to examinations, the diet plan can be changed and optimized. Preventive measures should be taken to regulate blood pressure. Relaxation techniques can help. They can be carried out at any time on one’s own responsibility and according to individual needs. In addition to yoga and meditation, methods such as Qi Gong or autogenic training are very popular for taking a break from the challenges of everyday life. Stress reduction helps keep blood pressure in the normal range. Taking walks and exercising regularly also have a positive effect on health. To strengthen the psyche and emotional stability, it is helpful if the patient focuses on leisure activities in which he or she experiences distraction and enjoys life. A sense of achievement should be built up through a variety of activities to promote confidence in one’s own skills. A communicative exchange with other patients can also be recommended. There, open questions can be clarified and tips for dealing with the disease can be given.
