Is My Pituitary Gland Missing in Empty Sella Syndrome?

Seeing the words “empty sella” on an MRI report can be alarming. It is natural to assume this means your pituitary gland is completely gone. Fortunately, in most cases, the gland is still there—it is simply flattened so much that the space it normally occupies looks empty on a scan ^[1][2].

What is Actually Happening?

The pituitary gland normally sits at the base of your brain inside a small, saddle-shaped bony cup called the sella turcica ^[1]. A protective membrane (the diaphragma sellae) covers the top of this cup, separating the gland from the cerebrospinal fluid (CSF) that bathes the brain ^[3].

In empty sella, this membrane is weak or incomplete ^[4]. This allows cerebrospinal fluid to extend or herniate down into the bony cup ^[3]. The normal pulsing of this fluid, sometimes combined with elevated fluid pressure in the head, presses the pituitary gland down ^[4]. Over time, the gland becomes flattened against the floor and walls of the sella turcica ^[1].

When a radiologist looks at the MRI, the bony cup appears to be filled with fluid rather than a plump, visible gland ^[3]. Radiologists often describe this as “partially empty” or “completely empty” based on how much fluid is visible ^[5]. However, “empty” is just a description of the image, not a diagnosis that the gland is missing ^[2].

Can a Flattened Gland Still Work?

Yes. Despite being compressed into a thin layer against the bone, the pituitary tissue often survives and can function normally ^[6][5].

Research shows that the size, volume, or shape of the pituitary gland on an MRI does not accurately predict how well it makes hormones ^[7][5]. While many people with this finding have entirely normal hormone function, others experience single or multiple hormone deficiencies ^[8][9]. Because the MRI cannot reveal how well the gland works, a diagnosis relies on reviewing your symptoms and conducting specific hormone tests ^[10][7].

Primary vs. Secondary Empty Sella

Doctors divide this condition into two categories based on why the space opened up:

• Primary empty sella: This happens when the membrane weakness occurs naturally, often associated with chronically high cerebrospinal fluid pressure (idiopathic intracranial hypertension) ^[4].
• Secondary empty sella: This occurs when the empty space is left behind after an event like pituitary surgery, radiation to the brain, severe head trauma, or an infarction (stroke) in a pituitary tumor ^[4][11]. In secondary empty sella, there may be genuinely less viable pituitary tissue remaining compared to primary cases ^[12].

What the “Syndrome” Means

If your MRI report says “empty sella,” it is simply describing an anatomical finding. It becomes known as “Empty Sella Syndrome” when the anatomical changes are accompanied by clinical consequences ^[13]. These consequences can include:

• Hormonal Deficiencies: Such as low levels of cortisol (central adrenal insufficiency), thyroid hormone, or sex hormones ^[9].
• Neurological Symptoms: Such as frequent headaches or visual changes, which may be driven by the underlying high fluid pressure or pressure on the optic nerves ^[4][14].

What This Means for You

Finding out you have an empty sella is a signal to investigate with an endocrinologist. They will usually order targeted blood tests—such as morning cortisol, free T4 and TSH, prolactin, IGF-1, and sex hormones—to see if the flattened gland is doing its job ^[10][9]. A single routine blood panel is rarely enough, and some patients require dynamic stimulation testing to uncover hidden deficiencies ^[10].

When to Seek Urgent Help

If you have empty sella syndrome and experience any of the following, seek prompt medical attention:

• Sudden or rapidly worsening vision loss or double vision (this may require urgent ophthalmologic evaluation) ^[14].
• Severe, sudden headache with repeated vomiting or confusion ^[4].
• Severe weakness, fainting, or inability to keep fluids down, especially if you have been diagnosed with or suspected to have cortisol deficiency (adrenal insufficiency) ^[9].