The sella turcica is a small bony cavity located in the center of the brain containing the pituitary gland (small gland). The empty sella turcica syndrome first of all corresponds to a misleading image: the pituitary is no longer seen in this compartment: it seems invisible and yet it is only flattened, repressed or hidden. It is the untimely irruption of cerebrospinal fluid into this cavity that puts pressure on the gland and compresses it without, however, altering its functioning.

In the vast majority of cases, this anomaly is not accompanied by any symptoms. The term “syndrome”, that is to say “all the symptoms or clinical signs” therefore seems very inappropriate.

The pituitary gland lies in a kind of gutter carved out of the surface of a bone (sphenoid bone) in the center of the brain, behind the eyes (which explains the possibility of visual disturbances in the presence of an abnormality of the gland). This gutter looks like a Turkish saddle hence its name of Turkish saddle. It is doubly an image since it suggests a horse saddle and it is visible on a skull x-ray and a fortiori on medical imaging (CT and MRI).

When we do not see the pituitary gland in its place in its compartment, we speak of an empty sella turcica. What happened ? The compartment was invaded by cerebrospinal fluid reducing the space allotted to the gland. This flattens out and is no longer visible. In most cases, this flattening has no consequences. But sometimes the function of the pituitary gland is stimulated or on the contrary infringed.

The pituitary is the size of a pea (10mm) and weighs 0,5g. And yet, it controls almost all the endocrine glands in the body. True, it is controlled itself by the hypothalamus above it, but it is it that secretes (makes and releases) six main hormones and a few more.

This is how it controls:

• thyroid (through thyroid stimulating hormone);
• adrenal cortex (via corticosteroids);
• testes and ovaries (through gonadotropins).

It ensures growth and physical development by secreting growth hormone and lactation by secreting prolactin. It is also thanks to it that the painful sensations are inhibited (endorphins) the water balance of the organism ensured (vasopressin), that the skin is colored (melanostimulin) and that uterine contractions are triggered during childbirth ( oxytocin). It is a “master” gland.

Let us return to this “empty” Turkic saddle. The cerebrospinal fluid, surrounding the brain and normally kept away from this compartment invades it, because the tissue barrier that protects it is deficient. The pressure due to this flood is exerted on the walls of the sella turcica and on the pituitary which stunted in a corner, disappearing with the imagery. In the vast majority of cases, the pituitary gland is not affected and is functioning normally.

But it happens that it malfunctions and we can understand that the symptoms can be very varied given its very large role. All the organs that it controls can be upset and start to function awry, either in less or in excess. The alteration of all the functions of the pituitary gland is called hypopituitarism 

Empty sella turcica syndrome is rare. It most often occurs in middle-aged, overweight and hypertensive women. We sometimes find a surgical intervention at the origin of this “accident”. Radiation therapy to the pituitary gland or necrosis of a pituitary tumor may also explain it. Headaches and high blood pressure are rare and even more so, a runny nose of cerebrospinal fluid or visual disturbances, the sella turcica being placed behind the optic nerves (the chiasma). 

There is no treatment especially when there are no clinical signs. Of course, if a hormonal insufficiency appears as a thyroid insufficiency, or a stop of the rules (amenorrhea), a replacement therapy aimed at replacing the missing hormone will be instituted. Likewise, high blood pressure and overweight will be treated. But again, empty sella turcica syndrome is not accompanied by clinical signs and is not treated.