What causes empty sella syndrome (ESS)?

What causes empty sella syndrome (ESS)?

Empty sella syndrome (ESS) can result from primary empty sella (PES) or secondary empty sella (SES), though it’s much more common to develop ESS from secondary empty sella.

Causes of primary empty sella syndrome (PES)

Primary empty sella (PES) happens when one of the layers (arachnoid) covering the outside of your brain bulges down into the sella turcica and presses on your pituitary gland.

Healthcare providers still don’t know the exact cause of primary empty sella syndrome.

One theory is that primary empty sella happens when a congenital defect in the tissue lining your brain creates the potential for cerebrospinal fluid to enter the sella turcica, flattening your pituitary gland. In these cases, the pituitary gland itself, while difficult to see on an imaging scan, is almost always functioning normally and doesn’t result in empty sella syndrome.

Causes of secondary empty sella (SES)

Secondary empty sella (SES) happens when your pituitary gland or the sella turcica is somehow damaged as a result of another condition or incident. For this reason, many things can cause SES. The general causes of damage include:

• A tumor.
• Radiation therapy.
• Brain surgery in the region of the pituitary gland.
• Head trauma (injury), such as a traumatic brain injury.

Some specific causes of secondary empty sella include:

• Brain tumors: Sometimes, brain tumors can cause increased pressure around your brain (intracranial pressure), which can lead to herniation of the subarachnoid space. This can lead to compression of your pituitary gland.
• Idiopathic intracranial hypertension (IIH): IIH is increased pressure in your skull that occurs because of cerebrospinal fluid (CSF) buildup around your brain. This extra pressure can lead to compression of your pituitary gland.
• Pituitary adenomas: A pituitary adenoma is a growth or tumor on your pituitary gland. They’re often noncancerous (benign). These adenomas can put pressure on your pituitary gland and damage it.
• Sheehan’s syndrome: Sheehan's syndrome is a condition that affects people who lose a life-threatening amount of blood during childbirth, which can deprive their bodies of oxygen. This lack of oxygen causes damage to their pituitary gland.