The sella turcica is a small depression in the sphenoid bone at the base of the skull. The pituitary gland sits above this depression, and the sella turcica provides support and protection for the gland. In empty sella syndrome, or ESS, the pituitary gland has flattened or shrunk, causing the sella turcica to appear to be empty. Empty sella syndrome occurs for a variety of reasons, including as a result of pituitary tumors or traumatic injuries.
Empty sella syndrome is classified into two different types: primary and secondary. In primary ESS, the cause of the syndrome is usually an anatomical defect that causes the pituitary gland to collapse on the surface of the sella turcica. One such defect is the result of a hole in the pituitary membrane. The hole allows excess fluid to get into the pituitary space, putting pressure on the gland and causing it to collapse. For women, pregnancy can be another cause. The pituitary gland may enlarge during pregnancy, but after a woman gives birth, it may shrink to less than its normal size. Also, the pituitary gland can shrink after menopause.
People with primary ESS are generally asymptomatic. Often someone with the syndrome is not diagnosed unless they undergo a medical imaging test for an unrelated reason. People with the primary syndrome sometimes have hypertension or headaches, but these symptoms are not caused by the syndrome. Other possible symptoms include low libido, irregular menstruation in women, and erectile dysfunction in men. People with this type of empty chair syndrome generally do not need treatment for the syndrome itself, but may need treatment for associated conditions, such as high blood pressure or sexual dysfunction.
In secondary ESS, the syndrome is the result of damage that causes the pituitary gland to shrink. Surgery, head trauma, or radiation therapy can cause damage to the pituitary gland that can lead to ESS. Alternatively, the syndrome may be the result of the growth of a tumor that invades the space occupied by the pituitary gland.
Hormones produced by the pituitary gland affect the sex organs, the thyroid, and the adrenal glands, so secondary ESS could be associated with defects in these organs. Symptoms of secondary empty chair syndrome vary according to the sex of the individual with the condition, due to the involvement of the sexual organs. Possible symptoms include infertility, low libido or sexual dysfunction, irregular or absent menstruation, reduced tolerance to infection, and a lower stress threshold. Treatment of secondary ESS symptoms involves synthetic hormone treatment to replace the missing hormones.