In the case of the empty sella syndrome (empty Stella syndrome), the pituitary gland, which sits 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 cause of the empty sella syndrome.
What is Empty Sella Syndrome?
If the pituitary gland is not visible in magnetic resonance imaging or computed tomography in the turcica area, the so-called Turkish saddle, the doctor speaks of the empty sella syndrome. A protrusion of the meninges is mainly responsible; this protuberance ensures that the pituitary gland cannot be recognized.
But that does not mean that the pituitary gland is absent; it is just not visible. As a rule, there are no complaints; However, if the patient complains of headaches, visual disturbances or a runny nose, treatment is required.
According to GROWTHEOLOGY, The so-called empty sella syndrome occurs predominantly in women who are in their middle years, have high blood pressure and are overweight. Such circumstances are therefore repeatedly referred to as risk factors. Empty Sella Syndrome occurs only rarely after radiation therapy, heart attacks or operations.
Doctors assume that a hormone deficit, which arose in early puberty, is responsible for the empty sella syndrome. So far, however, there is no 100 percent explanation why empty sella syndrome actually occurs.
Symptoms, ailments & signs
Often those affected have no symptoms at all. If the Empty Sella Syndrome is diagnosed even though there are no symptoms, it is usually an incidental diagnosis. This circumstance occurs when the patient is examined using magnetic resonance imaging or computed tomography due to other complaints.
Patients rarely suffer from headaches, constant runny nose (leakage of cerebrospinal fluid) and visual disturbances. If there are symptoms that suggest the Empty Sella Syndrome, the doctor recommends treating the syndrome based on the cause. However, if the patient is symptom-free, no treatments are carried out.
Diagnosis & course
As a rule, the Empty Sella Syndrome is only discovered by chance. However, if there is a suspicion – because the patient has several complaints – that suggest an empty sella syndrome, a computed tomography or magnetic resonance tomography is performed.
If the doctor does not discover a pituitary gland, he can assume that it is the so-called empty sella syndrome. If there are no complaints, he can dispense with other examinations. It is important, however, that those affected be examined – at regular intervals – so that any changes, if they occur, are recognized in good time.
The course of the disease depends on the circumstance of the cause. If there is a protrusion of the meninges, whereby the function of the pituitary gland is not impaired, the life expectancy of the patient remains unchanged. However, if there is an excess of prolactin or if the pituitary gland is sometimes underactive, then life expectancy will only remain unchanged.
However, this goes hand in hand with medication that regulates excess prolactin. If there is no treatment, the life expectancy is ten to a maximum of 15 years. As a rule, however, the Empty Sella Syndrome is symptom-free and uncomplicated.
When should you go to the doctor?
In most cases, empty sella syndrome does not require treatment. However, if there are complaints, it is best to speak to your family doctor. Frequent runny nose, blurred vision, and headaches are typical symptoms that require medical evaluation.
If the neurologist determines that there is excess prolactin or an underactive pituitary gland, treatment is required. Since the drugs typically prescribed are associated with side effects and interactions, close consultation with the doctor should be maintained during therapy.
After the treatment is complete, regular check-ups are indicated, otherwise the original symptoms can recur and sometimes cause serious complications. Empty Sella Syndrome primarily affects women who are overweight, have high blood pressure, or are about to go through menopause.
It also occurs more frequently after radiation therapy, heart attacks or operations. Patients at risk should speak to the responsible doctor in the event of the symptoms mentioned. In the event of severe complaints, it can make sense to call in the medical emergency service or go straight to the nearest hospital.
Treatment & Therapy
Before the doctor decides on treatment, he must first determine the cause of why an empty sella syndrome developed in the first place. If there are no complaints, no treatment is required. It is important that the patients nevertheless visit the doctor – at regular intervals – in order to have any check-ups carried out.
If there are changes, the doctor can react quickly. If there is a disease that is subsequently responsible for the Empty Sella Syndrome, the symptom resulting from it – i.e. the Empty Sella Syndrome – should not be treated, but the underlying disease. In this case, different therapies and treatments are available, depending on the underlying disease.
If the patient complains of a headache, a permanently runny nose or visual disturbances, the symptoms can be alleviated by minor interventions. The doctor takes care of the everted meninges, filling the sella with very small pieces of bone. The meninges can no longer protrude, so that the pituitary gland has enough 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 drugs.
Those are to be classified in the category of dopamine agonists. There is an automatic reduction in prolaction production. It should be noted that dopamine agonists are drugs that have a similar effect to dopamine. It is a messenger substance that stimulates the nervous system and the hypothalamus to inhibit the production of prolactin.
In this way, an excess of prolactin can subsequently be prevented. If the pituitary gland is underactive, it is important that the missing hormones are subsequently replaced with medication. If the doctor diagnoses a deficiency in growth hormones, he must therefore administer the corresponding growth hormones – by injection.
In the case of ACHTH deficiency, glucocorticoids are administered, but in the form of cortisone. If there is a deficiency in the thyroid hormone, tablets are given. As a rule, the hormones are administered for life. The only exception is growth hormones; those are only given up to a young age.
Outlook & forecast
In many cases, hormone replacement is sufficient for this acquired endocrinological disease. This means that any complaints that may arise can be treated well. The diagnosis of the syndrome, however, is usually made by chance. That can be a problem.
Many of those affected have no symptoms to complain about because of the empty sella syndrome. The prognosis for these patients is good. Although the pituitary gland is not visible during imaging tests, there does not seem to be any functional failures or disorders in many of those affected.
The prospects are somewhat worse if typical symptoms arise as a result of the empty sella syndrome. This could be a headache, a runny nose from leaking cerebrospinal fluid from the brain, or visual disturbances. If a prolactin excess is also diagnosed, this should be compensated for. If this does not happen because the acquired syndrome is not discovered, the survival expectancy is reduced to about 15 years after the occurrence of the empty sella syndrome.
Occasionally, an underactive pituitary gland is found in addition to the empty sella syndrome. This disorder can be regulated with tablets. The life expectancy of those affected is not restricted with professional treatment.
It is currently not known whether the underactive pituitary gland is the cause or effect of the empty sella syndrome. The prognosis is positive, provided the patient is closely monitored medically. The reason for this is the possible side effects of the therapy.
Empty Sella Syndrome cannot be prevented. Risk factors, such as obesity or high blood pressure, promote the Empty Sella Syndrome, although doctors are unsure whether – if the risk factors are eliminated – the syndrome can actually be prevented.
In the case of the Empty Sella Syndrome, the patient has very few options for follow-up care. First and foremost, the disease must be treated if there are complaints in everyday life. Furthermore, the identification of the underlying disease is usually very important so that the empty sella syndrome does not recur.
If the syndrome does not lead to any further complaints or complications in the day-to-day life of the person concerned, no treatment has to be carried out, and there are also no aftercare options. In some cases, people will need surgery to relieve the symptoms of the syndrome. After this procedure, the person concerned must always rest and take care of the body.
Exertion or stressful activities should therefore always be avoided in order to accelerate healing. Care by one’s own family or by friends and relatives also has a positive effect on the course of this disease.
Furthermore, in some cases the patients are dependent on the use of medication. It is important to ensure that it is taken regularly and correctly, and a doctor should always be consulted in cases of doubt. The life expectancy of those affected is not reduced by the empty sella syndrome.
You can do that yourself
Patients can do a lot to prevent empty sella syndrome and improve their wellbeing.
In particular, you should ensure that you maintain your normal weight. With a healthy and balanced diet and sufficient exercise, an increase in body weight can be prevented. The nutrition plan can be changed and optimized without further help or the use of examinations.
Preventive measures to regulate blood pressure should be taken. Relaxation techniques help with this. They can be carried out independently and according to individual needs at any time. In addition to yoga and meditation, methods such as Qi Gong or autogenic training are very popular to gain distance from the challenges of everyday life. The stress relief helps keep blood pressure within the normal range. Walks and regular exercise also have positive effects on health.
To strengthen the psyche and emotional stability, it is helpful if the patient concentrates on leisure activities in which he experiences distraction and a zest for life. A sense of achievement should be built up through various activities so that confidence in one’s own skills is promoted. A communicative exchange with other sick people can also be recommended. Open questions can be answered there and tips for dealing with the disease can be given.