Saudi Journal for Health Sciences

: 2020  |  Volume : 9  |  Issue : 1  |  Page : 75--76

Primary empty sella syndrome: An overview

Jamir Pitton Rissardo, Ana Letícia Fornari Caprara 
 Department of Neurology; Department of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brasil

Correspondence Address:
Dr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul

How to cite this article:
Rissardo JP, Caprara AL. Primary empty sella syndrome: An overview.Saudi J Health Sci 2020;9:75-76

How to cite this URL:
Rissardo JP, Caprara AL. Primary empty sella syndrome: An overview. Saudi J Health Sci [serial online] 2020 [cited 2022 Jun 28 ];9:75-76
Available from:

Full Text

Dear Sir,

We read the article entitled “Diverse clinical manifestations of empty sella syndrome: An imaging-based study” in the esteemed “Saudi Journal for Health Sciences” with great interest. Nwafor and Akhigbe retrospectively studied the cases of subjects that presented empty sella syndrome on the brain magnetic resonance imaging in their clinic. They conclude that this syndrome could present in many ways. Furthermore, they figured out that the majority of the patient's complaints can be explained by increased pressure on structures around the sella.[1]

Here, we would like to highlight some important topics that together with the study of Nwafor and Akhigbe could lead to a better comprehension of this syndrome. We done the mnemonic “CLEAR” to help remember the main differential diagnosis, which is the cystic lesions of the pituitary region, all of which displace the infundibulum to the sides of the fossa: 'C'ranyopharyngioma, 'L'arge (macro) adenoma, 'E'pidermoid cyst, 'A'rachnoid cyst, 'R'athke cleft cyst. These five cystic lesions are sometimes difficult to differentiate from a real empty sella, even though each of them has specific characteristics.[2]

As stated by Nwafor and Akhigbe, empty sella syndrome is a neuroendocrinological condition, which the pituitary gland is absent from the sella turcica and can be classified as primary or secondary. The focus of this manuscript will be recent original articles and reviews about the primary empty sella syndrome.[1]

Auer et al. systematically reviewed two databases for publications to answer if asymptomatic adult patients with primary empty sella syndrome should undergo other testing. One hundred and twenty publications were included; they concluded that basic endocrinological laboratories, which are cortisol, estradiol, insulin-like growth factor-1, prolactin, testosterone, and T4+, should be assessed in these patients. Furthermore, Auer et al. showed that there is an unconformity between the revealed prevalence of pituitary insufficiency among individuals with primary empty sella and its prevalence in other general epidemiological studies.[3]

Kayemba-Kay et al. assessed the association between primary empty sella syndrome and endocrinological manifestations in pediatric individuals. They found that primary empty sella in pediatric patients is rarely based on the prevalence of their clinic. Furthermore, their study showed that endocrinological examination is obligatory as well a long-term follow-up, because in an important percentage of the cases, there will be late manifestations of hormone deficiencies, mainly during childhood.[4]

In a Mexican case series study published last year, the objective was to provide a new surgical technique for the reconstruction of the sellar region floor using a heterologous bone. Three patients with primary sella turcica and visual field impairment were included. Guinto et al. had interesting results with all the patients with persistent visual improvement: in two patients this was immediately after surgery and in another only occurred about 1 week later.[5]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Nwafor NN, Akhigbe AO. Diverse clinical manifestations of empty sella syndrome: An imaging based study. Saudi J Health Sci 2019;8:172-5.
2Chiloiro S, Giampietro A, Bianchi A, Tartaglione T, Capobianco A, Anile C, et al. Diagnosis of endocrine disease: Primary empty sella: A comprehensive review. Eur J Endocrinol 2017;177:R275-R285.
3Auer MK, Stieg MR, Crispin A, Sievers C, Stalla GK, Kopczak A. Primary empty sella syndrome and the prevalence of hormonal dysregulation. Dtsch Arztebl Int 2018;115:99-105.
4Kayemba-Kay S, Ribrault A, Hindmarsh P. Primary Empty Sella Syndrome and Clnical Endocrine Polymorphisms in Children: A Report of 15 Cases. 57th Annual ESPE; 2018.
5Guinto G, Nettel B, Hernández E, Gallardo D, Aréchiga N, Mercado M. Osseous remodeling technique of the sella turcica: A new surgical option for primary empty sella syndrome. World Neurosurg 2019;126:e953-8.