Empty Sella on MRI: What the Finding Can Tell You

Reading “empty sella” in a scan report can make you wonder whether something is missing. Bring the full report to the clinician who requested the scan. Ask them to explain the finding before attaching it to every symptom you have been trying to understand.

What the scan describes

“Empty sella” describes a flattened pituitary gland on imaging. The sella is the compartment surrounding the gland; it is not literally empty and is often filled with cerebrospinal fluid. The finding may be discovered during a scan arranged for another reason.¹

Ask: “Was this an incidental finding, and what does the report say about my pituitary gland?” Keep the answer with the reason the scan was originally ordered.

What imaging does not settle

People can have an empty sella on imaging while their pituitary gland functions normally. Cleveland Clinic¹ distinguishes that finding from empty sella syndrome, in which the gland is not functioning properly. The scan description alone does not tell you which situation applies to you.¹

Ask: “What information do you need to assess function in my case?” Describe your symptoms and when they started. Bring your medicine list and relevant previous results, and ask how the clinician will consider them together.

Avoid deciding that the report explains fatigue or a change in your periods before the assessment. Equally, ask for an explanation if the finding is described as requiring no further action.

What further assessment may add

The clinician may order blood tests to check hormone levels. Assessment can also include a medical history and examination. The next step depends on the clinical findings, rather than being the same investigation for everyone.¹

Ask which tests are being considered, what question each would answer and whether you need a specialist appointment. Get preparation instructions from the service ordering the tests. Do not change a prescription to prepare unless the responsible clinician gives you directions.

What the treatment decision depends on

An empty sella with normal pituitary function does not itself require treatment. If hormone function is abnormal because of empty sella syndrome, treatment depends on which hormones are affected. A report is not an instruction to start hormone replacement.¹

Before the conversation ends, write down what has been established, what remains to be checked and who will review the results. Ask whom to contact if you develop concerns or do not receive the expected appointment or message.

My Body Changed. Now What? includes a Visit Brief and symptom diary. Use them to organize the report questions and symptom timeline alongside your clinician’s assessment. See the book.