Empty sella syndrome: an update

Empty sella is characterized by a flattened profile of the pituitary gland that represents in most cases only a radiological incidental finding. When endocrine, ophthalmic, and neurological symptoms occur, this condition is described as empty sella syndrome.

We searched MEDLINE (PubMed database) with the data filter 2024-2009 using the keywords listed above. The articles met the following inclusion criteria: 1) written in English; 2) published between 1 January 2009, and 31 December 2023; 3) original studies and case series on the epidemiology, characteristics, and treatment of empty sella and empty sella syndrome. Exclusion criteria included: articles written in languages other than English and single case report.

The incidence of empty sella is about 12%, when it comes to neuroimaging, while in clinical practice it can reach 35%. Endocrine pituitary disorders, defined as at least one hormone deficit, were reported in 19% to 40% of patients. Magnetic nuclear imaging (MRI) is confirmed to be the gold standard for radiological diagnosis of empty sella. If no alterations are detected it is suggested a careful revaluation at 24-36 months, in relation to the low risk of progression to PES syndrome.

Empty sella is, in most cases, a radiological finding without clinical manifestations. In people carrying empty sella hormonal pituitary evaluation should be assessed at the moment of the diagnosis, along with a careful imaging using MRI.