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PubMed This is a summary of 10 peer-reviewed journal articles Updated
Endocrinology · Empty Sella Syndrome

Understanding Empty Sella: The Basics

At a Glance

An "empty sella" on an MRI means cerebrospinal fluid has compressed your pituitary gland, making it hard to see. It does not mean the gland is missing. While often a harmless incidental finding, your doctor will check your hormone levels to rule out Empty Sella Syndrome.

Discovering the term “empty sella” on a brain scan report can be alarming. It may sound as though a vital part of your brain—the pituitary gland—is missing. However, in most cases, the gland is exactly where it should be; it has simply been flattened or compressed, making it harder to see on a standard MRI [1][2].

The Anatomy of the Sella

To understand this finding, it helps to visualize the “home” of the pituitary gland:

  • Sella Turcica: This is a small, saddle-shaped bony pocket at the base of the skull that cradles the pituitary gland [1].
  • Pituitary Gland: Often called the “master gland,” it produces hormones that regulate growth, metabolism, stress response, and reproduction [3].
  • Diaphragma Sellae: A thin membrane that acts like a ceiling over the sella turcica, separating the pituitary gland from the rest of the brain [4].
  • Cerebrospinal Fluid (CSF): The clear fluid that cushions the brain and spinal cord [4].

Why the Sella Looks “Empty”

An empty sella occurs when the diaphragma sellae (the “ceiling”) has a small opening or is weakened. This allows cerebrospinal fluid to leak into the sella turcica. The pressure from this fluid pushes the pituitary gland against the bony walls or floor of the sella [4].

Because the gland is flattened into a thin layer, it may not be visible to the radiologist, making the sella appear “empty” and filled only with fluid [1][2]. It is important to remember that a flattened gland is not a missing gland; people with this finding can have a pituitary that still functions normally [5][6].

Finding vs. Syndrome: Knowing the Difference

Doctors distinguish between a radiological “finding” and a clinical “syndrome.”

Term What it Means
Empty Sella Finding A purely visual observation on an MRI. It appears in up to 35% of people who have brain scans for unrelated reasons [2][7].
Empty Sella Syndrome (ESS) A condition where the empty sella is accompanied by actual symptoms or hormone imbalances due to a failing gland [4][1].

Is it Rare?

An empty sella is considered a common incidental finding, meaning it is often discovered by chance when a person receives an MRI for an unrelated reason, such as a head injury or a routine headache evaluation [2][6].

Next Steps and Evaluation

Current clinical guidelines recommend specific steps to evaluate this finding:

  1. Hormone Testing: A blood test to check your pituitary hormone levels (such as cortisol, thyroid-stimulating hormone, and prolactin) to evaluate if the gland is working correctly [8][9].
  2. Symptom Check: Doctors will look for signs of Idiopathic Intracranial Hypertension (IIH), a condition involving high pressure of the fluid around the brain, which is sometimes associated with an empty sella [4][10].

If you would like to know about how your condition is categorized, read our section on Primary vs. Secondary Empty Sella. To understand what signs to look for, visit Symptoms and the Hormonal Cascade.

Common questions in this guide

What does it mean if my MRI shows an empty sella?
An empty sella finding usually means your pituitary gland has been flattened against the bone by cerebrospinal fluid. It does not mean your pituitary gland is missing, and it is often found by chance when scanning for unrelated reasons.
Is an empty sella finding the same as Empty Sella Syndrome?
No. An empty sella is simply a visual finding on an MRI scan. Empty Sella Syndrome (ESS) is diagnosed only when this visual finding is accompanied by actual symptoms or hormone imbalances caused by a poorly functioning pituitary gland.
Will my pituitary gland still work if the sella is empty?
Yes, in many cases, a flattened pituitary gland still functions normally. Your doctor will likely order blood tests to check your hormone levels, such as cortisol and thyroid-stimulating hormone, to ensure the gland is working correctly.
What are the next steps after an empty sella is found on an MRI?
Your healthcare provider will typically order hormone blood tests to check your pituitary function. They may also evaluate you for symptoms of Idiopathic Intracranial Hypertension, a condition involving high fluid pressure around the brain.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my MRI, do I have a 'partially' or 'completely' empty sella, and does that change your approach to my care?
  2. 2.Which specific pituitary hormones (such as TSH, cortisol, or prolactin) should I have tested to ensure my gland is functioning correctly?
  3. 3.Does this finding explain the symptoms that led to my MRI, or should we continue looking for other causes?
  4. 4.Do I have any signs of idiopathic intracranial hypertension (IIH), such as papilledema, that might be related to this finding?
  5. 5.If my initial hormone tests are normal, what are the criteria for needing follow-up scans or blood work in the future?

Questions For You

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Related questions

Is My Pituitary Gland Missing in Empty Sella Syndrome?

References

References (10)
  1. 1

    A Comprehensive Review of Empty Sella and Empty Sella Syndrome.

    Lundholm MD, Yogi-Morren D

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2024; (30(5)):497-502 doi:10.1016/j.eprac.2024.03.004.

    PMID: 38484938
  2. 2

    Primary Empty Sella.

    Mehla S, Chua AL, Grosberg B, Evans RW

    Headache 2020; (60(10)):2522-2525 doi:10.1111/head.13987.

    PMID: 33038281
  3. 3

    Arginine vasopressin deficiency (central diabetes insipidus) with partial empty sella: a case report.

    Belay KE, Jemal RH, Kebede AH, et al.

    BMC endocrine disorders 2024; (24(1)):211 doi:10.1186/s12902-024-01741-y.

    PMID: 39379916
  4. 4

    Empty sella syndrome: Multiple endocrine disorders.

    Chiloiro S, Giampietro A, Bianchi A, De Marinis L

    Handbook of clinical neurology 2021; (181()):29-40 doi:10.1016/B978-0-12-820683-6.00003-8.

    PMID: 34238465
  5. 5

    Pituitary Volume in Patients with Primary Empty Sella and Clinical Relevance to Pituitary Hormone Secretion: A Retrospective Single Center Study.

    Akkus G, Sözütok S, Odabaş F, et al.

    Current medical imaging 2021; (17(8)):1018-1024 doi:10.2174/1573405617666210525111218.

    PMID: 34036923
  6. 6

    Asymptomatic Empty Sella Syndrome: A "New" Hypothalamic Pathology or Paraphysiological Variant.

    Masserini B, Rivolta B, Bernardi I, et al.

    Endocrine, metabolic & immune disorders drug targets 2024; doi:10.2174/0118715303314951240722093133.

    PMID: 39069798
  7. 7

    Empty Sella in Neuro-Ophthalmology Patients Without Raised Intracranial Pressure.

    Sayal AP, Jhaveri A, Diouf AA, et al.

    Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 2024; (44(1)):61-65 doi:10.1097/WNO.0000000000001741.

    PMID: 36730894
  8. 8

    Empty sella syndrome: an update.

    Padovano Sorrentino F, Chiloiro S, Giampietro A, et al.

    Pituitary 2024; (28(1)):13 doi:10.1007/s11102-024-01475-z.

    PMID: 39738761
  9. 9

    Clinical presentation, evaluation and case management of primary empty sella syndrome: a retrospective analysis of 10-year single-center patient data.

    Ekhzaimy AA, Mujammami M, Tharkar S, et al.

    BMC endocrine disorders 2020; (20(1)):142 doi:10.1186/s12902-020-00621-5.

    PMID: 32943019
  10. 10

    Clinical Characteristics of Idiopathic Intracranial Hypertension in Older Adults.

    Sabet SJ, Gasquet NC, Henderson AD, Carey AR

    Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 2024; (44(4)):502-506 doi:10.1097/WNO.0000000000002055.

    PMID: 38236646

This page explains the basics of an empty sella finding on an MRI for educational purposes. Always consult your endocrinologist or neurologist to interpret your specific scan results and hormone levels.

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