Empty Sella on MRI: What Does It Mean and What Happens Next?

Empty sella on MRI means the pituitary gland looks flattened or smaller than usual, and the bony pocket that holds it, the sella turcica, is filled partly or mostly with cerebrospinal fluid. The sella is not truly empty. It is often an incidental finding on a scan done for another reason, and in many people the pituitary still works normally.

This guide is for adults reading a head or pituitary MRI report that mentions an empty or partially empty sella. It explains common terms and questions to ask. It cannot tell you whether your own finding matters, and it does not replace the advice of the clinician who ordered the scan.

Raised pressure around the brain, called intracranial hypertension, is one of the conditions linked to an empty sella. The NHS describes symptoms such as a persistent throbbing headache that may be worse in the morning or when coughing or straining, brief episodes of dimmed or greyed-out vision, nausea or vomiting, and a rhythmic pulsing sound in the ears. If you notice these, contact a clinician promptly rather than waiting for a routine follow-up.

Get emergency help through local services if headache or vision symptoms start suddenly, follow a recent head injury, or come with a high temperature or feeling very unwell. Clear, watery fluid dripping from the nose is a rare problem described with empty sella; mention it to a clinician soon.

Signs of low pituitary hormones can include tiredness and weakness, dizziness or fainting, missed or irregular periods, reduced sex drive, erection problems or unexpected nipple discharge. These are worth reporting, even if they seem minor.

Cleveland Clinic describes empty sella as a radiological finding and empty sella syndrome as a condition. The syndrome means the scan finding comes with problems such as abnormal hormone levels. Cleveland Clinic estimates that 8% to 35% of people have an empty sella, and that fewer than 1% of people with the finding develop symptoms.

Doctors also separate primary and secondary empty sella. Primary empty sella has no identified cause; MedlinePlus explains that the membrane covering the brain can bulge into the sella and press on the gland. Secondary empty sella follows damage to the pituitary, for example from a tumour, surgery, radiation or head injury, or from raised pressure around the brain. Secondary cases are more likely to affect hormones and vision.

Reports may say "partially empty" when some pituitary tissue is still clearly visible and only part of the sella is filled with fluid. A completely empty sella describes more fluid and a thinner rim of gland. A 2024 literature review notes that radiology papers use measurement-based definitions, but these vary and are not a diagnosis on their own.

The wording on the report describes appearance, not how well the gland works. Only blood tests and a clinical assessment can show whether hormone levels are normal. If the report mentions other findings, such as a small pituitary lesion, ask how they relate. The SameCase guide on pituitary microadenoma covers that separate finding.

The pituitary controls several other glands, so a clinician may check hormone levels to make sure it is working normally. MedlinePlus lists tests used when low pituitary function is suspected, including ACTH, cortisol, TSH and thyroid hormone (T4), FSH, LH, oestradiol or testosterone, and IGF-1, a marker related to growth hormone.

Prolactin may also be measured. MedlinePlus notes that prolactin can be slightly high with primary empty sella. A raised result has many possible causes, so it needs interpretation alongside symptoms and medicines. Reference ranges differ between laboratories; compare your result with the range printed on your own report. Our guide on high prolactin levels explains the wider picture.

Which tests are needed, and when, is a decision for the treating team. Some tests depend on the time of day or other conditions, so follow the instructions you are given.

It can be. Both MedlinePlus and Cleveland Clinic list idiopathic intracranial hypertension, raised pressure around the brain without a clear cause, among the conditions associated with empty sella. This does not mean everyone with the finding has raised pressure.

If symptoms suggest raised pressure, a clinician may examine the back of the eyes for swelling of the optic nerve, arrange formal eye tests, or consider a lumbar puncture to measure pressure. Tell your clinician about headaches, vision changes or pulsing sounds in the ears, because these help decide whether this question needs exploring.

According to MedlinePlus and Cleveland Clinic, no treatment is needed when pituitary function is normal, which is the most common situation. If hormone levels are low, hormone replacement may be considered. If fluid leaks from the nose, surgery to repair the area may be needed. Any treatment depends on the cause and on test results, not on the scan wording alone.

Ask whether any follow-up imaging or repeat blood tests are planned, and who will contact you with results.

Bring a copy of the full MRI report and any blood results to your appointment. These questions can help you leave with a clear plan.

• Is this a primary or secondary empty sella, and does that change anything for me?
• Have my pituitary hormones been checked, or do I need blood tests? Do I need to prepare for them in any way?
• Could any of my symptoms, such as headaches, tiredness or period changes, be related, or are they likely to have another cause?
• Do I need an eye examination or visual field test to look for signs of raised pressure?
• Is follow-up imaging or a referral to an endocrinologist recommended?
• Which new symptoms should make me contact you sooner, and how do I do that?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with an empty sella on MRI described their reports, tests and follow-up can help you notice questions you had not thought to ask. Every case is different, and other people's experiences cannot tell you what your own finding means. Take the questions you gather to your own clinician, who knows your history and results.