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Empty Sella Turcica

Remember the Sella Turcica from anatomy? It’s the depression in the sphenoid bone, in which the pituitary gland sits. Like many anatomical landmarks knowing the Latin can help us make sense of the naming. Sella Turcica is Latin for “Turkish seat” or “saddle”. For those of you who are not John Wayne fans (does Rooster Cogburn, True Grit, or Big Jake ring a bell? If not go rent a movie); a saddle is the seat strapped to the back of a horse; it’s the preferred mode of transportation for the American cowboy. That makes our pituitary gland a little cowboy right? Yee Doggie!

I digress but- picture a little saddle in the sphenoid bone with the pituitary sitting in it and that’s it! You know what the Sella Turcica looks like.

Here is the clinical scenario: You have a patient come in with a neurological complaint - intracranial bleed, seizure or a complicated migraine syndrome. It is warranted to investigate with brain MRI. Being the astute radiologist you are, you notice that the Sella Turcica is empty and our “pituitary cowboy” is missing in action.

This incidental finding of no pituitary gland in the Sella turcica is abnormal. However, if the patient is not having endocrine abnormalities (HPA axis, lactating, amenorrhea, etc); then do not worry. If it ain’t broke- don’t’ fix it. This finding requires no further work up. This is an anatomical variant, the pituitary is still present and functional. It is just not in the normal location. This is labeled as primary empty Sella turcica (ESS).

On the other hand, if a patient presents after a head injury, radiation or surgery and has symptoms that reflect the loss of pituitary function (intolerance to infections, stress), and you find the pituitary gland missing, then we would call this secondary empty Sella turcica.

To summarize: Empty Sella turcica is when the pituitary gland is not found in the Sella turcica. If patient is asymptomatic, this is consistent with primary ESS. If the patient has symptoms of dysfunctional pituitary gland, then this goes with secondary

ESS.

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