The most common cause is a large opening in the diaphragma sellae, a membrane which sits on top of the pituitary and protects it in its socket within the bones at the base of the skull. When this opening is large, the spinal fluid pressure is transmitted to the pituitary and flattens it out within the sella. Generally, in this situation, pituitary function is normal, but a number of patients have headaches, mild hyperprolactinemia, galactorrhea, and irregular menses. In most cases, however, the pituitary functions normally as evidenced by normal thyroid functions, normal tests of adrenal function, normal somatomedin-C levels, and regular menses. Some patients have empty sella syndrome as a result of other processes such as neurosarcoidosis pituitary tumors that have degenerated, etc.
Rare patients have a congenital empty sella and a coexisting pituitary tumor.
Unless the disorder results in other medical problems, treatment is symptomatic and supportive. In some cases, surgery may be needed.