cerebral atrophic changes, partial empty sella

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The mild diffuse cerebral atrophic changes are those that occur as we age. As persons age, the brain tissue shrinks or atrophies. This is a very common finding on MRI. At what point does the atrophy become a problem, can be determine with some cognitive testing. But, usually, mild changes would not cause any functional impairments for the patient, in terms of reasoning, thinking, or memory. If however, there is concern for a functional impairment, again, neuropsychiatric testing can be performed.

An empty sella may affect the pitutary gland. Empty sella syndrome (ESS) is a condition in which the pituitary gland shrinks or becomes flattened.

CAUSES
The pituitary gland is a small gland located at the base of the brain. It sits in a saddle-like compartment in the skull called the "sella turcica," which in Latin means "Turkish saddle". When the pituitary gland shrinks or becomes flattened, it cannot be seen on MRI scans, giving the appearance of an "empty sella." This is referred to as empty sella syndrome.

The pituitary makes several hormones that control the other glands in the body, including the:
* Adrenal glands
* Ovaries
* Testicles
* Thyroid

Primary empty sella syndrome occurs when a hole in the membrane covering the pituitary gland allows fluid in, which presses on the pituitary. Secondary empty sella syndrome occurs when the sella is empty because the pituitary gland has been damaged by a tumor, radiation therapy, or surgery.


SYMPTOMS
Often, there are no symptoms or loss of pituitary function.

Patients with empty sella syndrome may have symptoms caused by a partial or complete loss of pituitary gland function.
Symptoms may include:
* Erectile dysfunction (impotence)
* Headaches
* Irregular or absent menstruation
* Low sexual desire (low libido)
* Nipple discharge, even in males


EXAMS and TESTS
Primary empty sella syndrome is most often discovered during radiological imaging of the brain. Pituitary function is usually normal.

The health care provider may test pituitary gland function to make sure that the gland is working normally. Sometimes tests for high pressure in the brain will be done, such as an examination of the retina by an ophthalmologist or a lumbar puncture (spinal tap).

The hormone prolactin is a little high in a small percentage of patients, which may interfere with the normal function of the testicles or ovaries.


TREATMENT
For primary empty sella syndrome:
* There is no specific treatment if pituitary function is normal.
* Medications, such as bromocriptine, which lower prolactin levels, may be prescribed if the prolactin levels are high and interfering with function of the ovaries or testes.

For secondary empty sella syndrome:
* Treatment involves replacing the hormones that are lacking.


OUTLOOK (Prognosis)
Primary empty sella syndrome does not cause health problems, and it does not affect life expectancy.

Possible Complications
Complications of primary empty sella syndrome include mild hyperprolactinemia. Complications of secondary empty sella syndrome are related to the cause of pituitary gland disease or to the effects of too little pituitary hormone.


REFERENCE
Melmed S, Kleinberg D. Anterior pituitary. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. Philadelphia, PA: Saunders Elsevier; 2008:chap 8.