Empty sella syndrome (ESS) is a disorder that involves the sella turcica, a bony structure at the base of the brain that surrounds and protects the pituitary gland. ESS is often discovered during imaging tests for pituitary disorders.

An individual with ESS may have no symptoms or may have symptoms resulting from partial or complete loss of pituitary function including:

• Headaches,
• Low sex drive
• Impotence (erectile dysfunction)

There are two types of ESS: Primary and Secondary.

1. Primary ESS happens when a small anatomical defect above the pituitary gland allows spinal fluid to partially or completely fill the sella turcica. This causes the gland to flatten out along the interior 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 usual
    
2. Secondary ESS is the result of the pituitary gland regressing within the cavity after an injury, surgery, or radiation therapy. Individuals with secondary ESS can sometimes have symptoms that reflect the loss of pituitary functions, such as
   • Ceasing of menstrual periods
   • Infertility
   • Fatigue
   • Intolerance to stress and infection

In children, ESS may be associated with early onset of puberty, growth hormone deficiency, pituitary tumors, or pituitary gland dysfunction. Magnetic resonance imaging (MRI) is useful in evaluating ESS.

Unless the syndrome results in other medical problems, treatment is symptomatic and supportive as ESS is not a life-threatening condition.