Diagnostic pitfalls of Empty Sella Syndrome: a case report

Živilė Vaičekauskytė1, Ieva Monika Žiaukaitė1, Dr. Greta Pšemeneckienė1

1Lithuanian University of Health Sciences, Medical Academy, Faculty of medicine. Kaunas, Lithuania.


Empty sella is usually an accidental finding in visual brain examinations without clinical presentation. However, some of them diagnosed with empty sella syndrome experience a variety of symptoms. One of many concerning symptoms are headaches and visual disturbance which are caused by increased intracranial pressure. In rare cases increased intracranial pressure can result in critical conditions as in liquorrhea. In empty sella syndrome neuroendocrine system can be affected due to compression on the pituitary gland. Impairment of the neuroendocrine axis results in hormonal imbalance. Diagnosing empty sella syndrome is challenging for physicians. Due to the wide range of symptoms, patients are often examined by several specialists who only focus on the clinical manifestations of their field of expertise and an accurate diagnosis is made after years. In absence of clear diagnostic and treatment algorithms, patients with empty sella syndrome face many problems related to regular disease monitoring. There are no confirmed recommendations which specialist has to manage patients with empty sella syndrome. Currently, these patients are supervised by a multidisciplinary team consisting a neurologists, ophthalmologists, and endocrinologists. In this article, we report a case of empty sella syndrome with multiple diagnostic challenges.

Keywords: empty sella syndrome, empty sella, intracranial hypertension, hypophyseal axis.