Empty Sella Syndrome: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Empty Sella Syndrome?
An endocrinologist, a doctor who treats hormone problems, usually looks after empty sella syndrome. A neurologist, a doctor who treats brain and nerve conditions, may help when pressure in the head is a concern. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is empty sella syndrome?
Empty sella syndrome is a rare condition that affects the pituitary gland. The pituitary is a small gland just under the brain. It makes hormones, which are chemical messengers that help control other glands in the body.
The pituitary sits in a bony hollow at the base of the skull. This hollow is called the sella turcica, or just the sella. In this condition, the pituitary gland shrinks or becomes flattened. On a scan, the sella looks empty.
But the sella is not really empty. It is often filled with cerebrospinal fluid, the fluid that surrounds the brain and spinal cord.
Symptoms
Often, there are no symptoms. When symptoms do appear, they may include:
- Headaches.
- Irregular or absent menstrual periods.
- Erection problems.
- Low desire for sex.
- Fatigue and low energy.
- Nipple discharge.
Some people with the secondary type have trouble handling stress and infections, or have trouble getting pregnant. Many children with this condition have no symptoms. Some may have early puberty, slow growth, or vision problems.
Causes and who gets it
There are two types. In primary empty sella syndrome, a layer covering the outside of the brain bulges down into the sella and presses on the pituitary. Doctors use the word primary when no other cause is found. It is found most often in women who have had several children and in people with obesity. It can also occur with pseudotumor cerebri, which raises fluid pressure in the head.
In secondary empty sella syndrome, the pituitary was damaged by a tumor, radiation therapy, surgery, or an injury. The damaged gland shrinks, and many of these people have low pituitary hormone levels.
This condition is very rare in children. Some children are born with structural problems in the sella.
How doctors diagnose it
Doctors often find it by chance. A scan of the brain, such as an MRI or CT, is often done for another reason. If part of the gland can still be seen, doctors call it a partial empty sella.
If symptoms point to a hormone problem, blood tests can measure pituitary hormone levels. Doctors may also check for high pressure in the head. Tests for this include an eye exam by an eye doctor and a lumbar puncture, also called a spinal tap.
Treatment
People with no symptoms do not need treatment. Regular checkups can help doctors keep watch over time. In primary empty sella syndrome, medicines may be given if hormone levels are abnormal.
For secondary empty sella syndrome, treatment replaces the missing hormones. People with obesity may be able to ease their symptoms with lifestyle changes that help manage body weight. In rare cases, surgery is used. A shunt, which is a small tube, may relieve pressure on the brain. Surgery may also repair the sella to stop fluid from leaking into the nose and sinuses.
When to see a doctor
Contact your doctor if you have signs of a pituitary problem, such as menstrual cycle problems or erection problems. Also tell your doctor about headaches or vision changes.
Call 911 or go to the emergency room if you have sudden dizziness, weakness, or a sudden change in vision, sudden severe pain anywhere in the body, or you faint. Also call 911 if you have low pituitary hormones and get confused, very weak, or a high fever. This may be adrenal crisis, a life-threatening lack of cortisol.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A doctor like this can order the first blood tests, review scan results, and watch your symptoms over time. They can also help coordinate visits with an endocrinologist.
Common questions
Is empty sella syndrome life threatening?
Usually not. The condition itself is not life threatening, and the primary type does not change life expectancy. But too little cortisol, a stress hormone, can cause adrenal crisis. Tell your doctor about any symptoms, such as headaches.
Does empty sella syndrome always need treatment?
No. People who have no symptoms do not need treatment. Doctors may suggest regular checkups to watch the condition, and treatment is used if hormone levels are low or other problems appear.
Is the sella really empty?
No. The sella is not actually empty. It looks empty on a scan because the pituitary gland has shrunk or flattened, and the space is often filled with cerebrospinal fluid.
Can children get empty sella syndrome?
Yes, but it is very rare. Many children with it have no symptoms, though some may have early puberty, slow growth, or vision problems.
Sources
- MedlinePlus - Empty sella syndrome
- National Institute of Neurological Disorders and Stroke - Empty Sella Syndrome
- MedlinePlus - Acute adrenal crisis
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
