EMPTY SELLA SYNDROME

Course overview

EMPTY SELLA SYNDROME (ESS), ALSO KNOWN AS ARACHNOIDOCELE, IS A RADIOLOGIC FINDING IN WHICH THE SELLA TURCICA APPEARS EMPTY DUE TO CEREBRAL SPINAL FLUID (CSF) WITHIN THE SUBARACHNOID SPACE HERNIATING INTO THE SELLA TURCICA. SUBSEQUENTLY, THE PITUITARY GLAND CONTAINED IN THE SELLA TURCICA IS COMPRESSED AND FLATTENED, AND THE PITUITARY STALK IS STRETCHED BY THE CSF, WHICH FILLS THE SPACE. OVER THE YEARS, RADIOLOGISTS NOTICED A SIMILAR PHENOMENON IN CT AND MRI BRAIN IMAGING, FURTHER REFINING THE TERM EMPTY SELLA. ESS IS THE CONDITION ASSOCIATED WITH THIS FINDING THAT MAY PRESENT WITH SYMPTOMS INCLUDING HEADACHE AND VISUAL CHANGES. ESS IS COMMONLY CLASSIFIED INTO 2 ETIOLOGIC CATEGORIES: PRIMARY EMPTY SELLA (PES), WHICH HAS NO IDENTIFIED UNDERLYING CAUSE, AND SECONDARY EMPTY SELLA (SES), WHICH HAS AN IDENTIFIABLE ETIOLOGY (EG, CEREBRAL TRAUMA AND POSTPARTUM PITUITARY NECROSIS). ESS CAN BE FURTHER SUBDIVIDED INTO COMPLETE AND PARTIAL TYPES, WITH THE LATTER REFERRING TO THE SELLA TURCICA BEING LESS THAN 50% FILLED WITH CSF AND THE FORMER BEING MORE THAN 50% FILLED WITH CSF.DUE TO ADVANCES IN RADIOLOGIC TECHNOLOGY, THE INCIDENCE OF EMPTY SELLA HAS RECENTLY INCREASED. ALTHOUGH EMPTY SELLA HAS HISTORICALLY BEEN CONSIDERED AN INCIDENTAL FINDING WITHOUT CLINICAL SIGNIFICANCE, RECENT EVIDENCE SUGGESTS THAT PATIENTS MAY HAVE ASSOCIATED SYMPTOMS, OTHERWISE KNOWN AS ESS, MORE FREQUENTLY THAN PREVIOUSLY BELIEVED. CONSEQUENTLY, MOST EXPERTS RECOMMEND A THOROUGH EVALUATION IN ALL PATIENTS INITIALLY FOUND TO HAVE EMPTY SELLA; REEVALUATION IN ASYMPTOMATIC PATIENTS MAY BE REASONABLE ALSO. SYMPTOMATIC PATIENTS WITH ESS SHOULD BE MANAGED SUPPORTIVELY; THE TYPE OF TREATMENT INDICATED CAN VARY FROM PHARMACOLOGIC (EG, GROWTH HORMONE REPLACEMENT) TO SURGICAL (EG, LUMBAR PERITONEAL SHUNT) THERAPIES. BECAUSE THIS CONDITION IS BEING IDENTIFIED MORE FREQUENTLY AND MAY BE ASSOCIATED WITH MORE SYMPTOMS THAN PREVIOUSLY BELIEVED, CLINICIANS SHOULD BE FAMILIAR WITH THIS FINDING AND THE VARIETY OF POTENTIAL PRESENTATIONS. THIS ACTIVITY WILL ENHANCE THE HEALTHCARE PROFESSIONAL'S COMPETENCE IN DIAGNOSING AND MANAGING EMPTY SELLA SYNDROME AND HIGHLIGHT THE CRITICAL NEED FOR COLLABORATION AMONG MULTIDISCIPLINARY TEAM MEMBERS SUCH AS OPHTHALMOLOGY, NEUROLOGY, AND ENDOCRINOLOGY CLINICIANS TO IMPROVE PATIENT OUTCOMES.