Case Study 220 | Empty Sella Syndrome | Presented by Dr. Betsy Grunch

𝐂𝐚𝐬𝐞 𝐒𝐭𝐮𝐝𝐲 𝟐𝟐𝟎 | 𝐄𝐦𝐩𝐭𝐲 𝐒𝐞𝐥𝐥𝐚 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞 Empty Sella Syndrome occurs when the 𝐬𝐞𝐥𝐥𝐚 𝐭𝐮𝐫𝐜𝐢𝐜𝐚 - 𝐭𝐡𝐞 𝐬𝐦𝐚𝐥𝐥 𝐛𝐨𝐧𝐲 𝐜𝐚𝐯𝐢𝐭𝐲 𝐭𝐡𝐚𝐭 𝐡𝐨𝐮𝐬𝐞𝐬 𝐭𝐡𝐞 𝐩𝐢𝐭𝐮𝐢𝐭𝐚𝐫𝐲 𝐠𝐥𝐚𝐧𝐝 - 𝐚𝐩𝐩𝐞𝐚𝐫𝐬 𝐩𝐚𝐫𝐭𝐢𝐚𝐥𝐥𝐲 𝐨𝐫 𝐜𝐨𝐦𝐩𝐥𝐞𝐭𝐞𝐥𝐲 𝐟𝐢𝐥𝐥𝐞𝐝 𝐰𝐢𝐭𝐡 𝐜𝐞𝐫𝐞𝐛𝐫𝐨𝐬𝐩𝐢𝐧𝐚𝐥 𝐟𝐥𝐮𝐢𝐝, causing the pituitary to become flattened along the walls of the sella. The pituitary may still function normally, but in some patients this pressure can disrupt hormone signaling and lead to symptoms like: • Chronic headaches • Vision changes • Fatigue • Menstrual irregularities or fertility issues • Low thyroid, adrenal, or growth hormone levels There are two forms: 𝐏𝐫𝐢𝐦𝐚𝐫𝐲 𝐄𝐦𝐩𝐭𝐲 𝐒𝐞𝐥𝐥𝐚 - often related to a congenital weakness in the diaphragm sellae that allows CSF to press into the space. 𝐒𝐞𝐜𝐨𝐧𝐝𝐚𝐫𝐲 𝐄𝐦𝐩𝐭𝐲 𝐒𝐞𝐥𝐥𝐚 - occurs after surgery, radiation, tumors, trauma, or pituitary infarction that causes the gland to shrink. Diagnosis is usually made on 𝐌𝐑𝐈, but imaging alone isn’t the whole story. The real question is whether the pituitary hormones are functioning normally. Treatment depends on symptoms: • Many patients need 𝐧𝐨 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐚𝐭 𝐚𝐥𝐥 • Others require 𝐡𝐨𝐫𝐦𝐨𝐧𝐞 𝐫𝐞𝐩𝐥𝐚𝐜𝐞𝐦𝐞𝐧𝐭 if deficiencies are present • Rarely, neurosurgical intervention is needed if associated with CSF leaks or elevated intracranial pressure It’s a great reminder that 𝐫𝐚𝐝𝐢𝐨𝐥𝐨𝐠𝐲 𝐟𝐢𝐧𝐝𝐢𝐧𝐠𝐬 𝐝𝐨𝐧’𝐭 𝐚𝐥𝐰𝐚𝐲𝐬 𝐞𝐪𝐮𝐚𝐥 𝐝𝐢𝐬𝐞𝐚𝐬𝐞 - and clinical context matters. #CaseStudy220 #Neurosurgery #SundayCaseStudy #EmptySellaSyndrome #LadySpineDoc