Essential Screening: Blood Tests for Empty Sella Syndrome

Essential Screening: Blood Tests for Empty Sella Syndrome

Blood tests for empty sella syndrome (ESS) are done to check the levels of pituitary hormones in the blood. These hormones include growth hormone, prolactin, thyroid-stimulating hormone, adrenocorticotropic hormone, luteinizing hormone, and follicle-stimulating hormone. 

Low or high levels of these hormones can indicate pituitary gland dysfunction due to ESS. Blood tests can also measure cortisol and thyroid hormones, which the pituitary gland regulates.

Read on to better understand the blood tests used to diagnose and treat Empty Sella Syndrome. This post explains the hormone checks that aid in identifying this condition, supported by cited sources. It clarifies how these tests lead to appropriate treatment for ESS patients.

blood tests for empty sella syndrome
Blood tests for empty sella syndrome

What is Empty Sella Syndrome?

Empty Sella Syndrome (ESS) is a rare condition that affects the pituitary gland, a small structure at the base of the brain that produces hormones. 

Empty Sella Syndrome occurs when the bony structure surrounding and protecting the pituitary gland, called the sella turcica, is partially or entirely filled with cerebrospinal fluid (CSF). This fluid surrounds the brain and spinal cord. This causes the pituitary gland to shrink or flatten, which may affect its function and hormone levels. 

Empty Sella Syndrome can be primary or secondary, depending on the cause. Primary ESS is usually asymptomatic and discovered incidentally during imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain. 

Secondary Empty Sella Syndrome is caused by damage to the pituitary gland from surgery, radiation, injury, or disease. It may lead to symptoms of hormonal deficiency, such as headaches, impotence, menstrual irregularities, and fatigue. 

The diagnosis of Empty Sella Syndrome involves blood tests to measure hormone levels, such as thyroid stimulating hormone (TSH), cortisol, prolactin, and testosterone, and radiological tests to examine the structure of the sella turcica and the pituitary gland. 

The treatment of ESS depends on the type, the symptoms, and the hormone levels. Some patients may not require any treatment, while others may need hormone replacement therapy or surgery.

ESS is not a life-threatening condition, but it may affect the patients' quality of life and health. Therefore, regular check-ups and screening tests are recommended for people with ESS.

Empty sella syndrome and weight gain

Causes and Risk Factors Empty Sella Syndrome

The causes of Empty Sella Syndrome (ESS) can be primary or secondary, depending on the underlying mechanism leading to the pituitary gland's flattening or shrinking. 

Primary Empty Sella Syndrome is usually idiopathic, meaning no known cause exists. It may be related to a congenital disability in the diaphragm sellae, a membrane that covers the sella turcica and prevents the cerebrospinal fluid (CSF) from entering the space. 

Some people are born with a small tear in the diaphragm sellae, which allows the CSF to leak into the sella turcica and compress the pituitary gland. 

Secondary Empty Sella Syndrome is caused by damage to the pituitary gland from external factors, such as surgery, radiation therapy, infection, trauma, or tumor. These factors can destroy or reduce the pituitary tissue, leaving an empty space filled by the CSF. 

The risk factors for Empty Sella Syndrome are not well understood. Still, some studies have suggested that obesity, hypertension, and female gender, especially those who have had multiple pregnancies, are more likely to develop ESS. 

These factors may increase the pressure inside the skull, affecting the pituitary gland and the sella turcica. However, most cases of Empty Sella Syndrome are asymptomatic and discovered incidentally during imaging tests, so the true prevalence and risk factors of ESS are hard to determine.

The Role of Blood Tests in Diagnosing Empty Sella Syndrome

Why Blood Tests are Important

Blood tests are essential for diagnosing Empty Sella Syndrome (ESS), as they can reveal the level and function of the hormones produced by the pituitary gland. 

The pituitary gland regulates many vital processes in the body, such as growth, metabolism, reproduction, and stress response. 

Therefore, any damage or compression of the pituitary gland can lead to hormonal imbalances that can cause various symptoms and complications. 

Some of the common hormones that are measured in blood tests for ESS are:

Thyroid-stimulating hormone (TSH): 

This hormone stimulates the thyroid gland to produce thyroid hormones, which control the rate of metabolism and energy use in the body. 

Low levels of TSH can indicate hypothyroidism, a condition where the thyroid gland is underactive and does not produce enough thyroid hormones. 

Symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, dry skin, and hair loss.


This hormone is released by the adrenal glands in response to stress. It helps the body cope with physical and emotional challenges by increasing blood sugar, blood pressure, and heart rate. 

High cortisol levels can indicate Cushing's syndrome, a condition where the body produces too much cortisol. 

Symptoms of Cushing's syndrome include obesity, moon face, purple stretch marks, thin skin, and muscle weakness. 

Low cortisol levels can indicate Addison's disease, a condition where the adrenal glands do not produce enough cortisol. 

Symptoms of Addison's disease include weight loss, low blood pressure, salt craving, and darkening of the skin.


This hormone stimulates breast milk production in women and plays a role in fertility and sexual function in both men and women. 

High prolactin levels can indicate hyperprolactinemia, where the pituitary gland produces too much prolactin. 

Symptoms of hyperprolactinemia include irregular menstrual periods, infertility, galactorrhea (abnormal milk discharge from the breasts), and sexual dysfunction. Low levels of prolactin are rare and usually do not cause any symptoms.


  • This hormone is responsible for the development of male sexual characteristics and the maintenance of muscle mass, bone density, and libido. 
  • Low levels of testosterone can indicate hypogonadism, a condition where the testicles do not produce enough testosterone. 
  • Symptoms of hypogonadism include erectile dysfunction, decreased sperm count, reduced muscle mass, osteoporosis, and mood changes.

Blood Tests for Empty Sella Syndrome are usually done after fasting for at least eight hours, as food intake can affect some hormones. 

The blood samples are collected from a vein in the arm and sent to a laboratory for analysis. The results are compared with the normal ranges for each hormone and interpreted by a doctor.

Depending on the results, further tests may be required to confirm the diagnosis of Empty Sella Syndrome or rule out other conditions that can cause similar symptoms. 

For example, a stimulation test can be done to measure how the pituitary gland responds to certain substances that generally trigger the release of hormones, such as thyrotropin-releasing hormone (TRH), corticotropin-releasing hormone (CRH), or insulin. 

A dynamic MRI scan can also be done to visualize the structure and function of the pituitary gland and the sella turcica.

Blood tests are a crucial tool for diagnosing Empty Sella Syndrome, as they can provide valuable information about the pituitary gland's functionality and the patient's hormonal status. 

By measuring the levels of different hormones in the blood, doctors can identify any hormonal imbalances that might be causing the symptoms of ESS and determine the appropriate treatment options. 

Blood Tests for Empty Sella Syndrome can also help monitor the response to treatment and the patient's long-term outcome.

Lose Weight with Empty Sella Syndrome: A Holistic Approach

What Blood Tests Can Reveal

Blood tests are a critical component in the Empty Sella Syndrome (ESS) diagnostic process, offering a window into the intricate hormonal landscape governed by the pituitary gland. 

When a patient is suspected of having ESS, blood tests can provide invaluable insights beyond the findings of an MRI or CT scan.

Hormonal Imbalances and Pituitary Function: 

The primary objective of blood tests in the context of ESS is to measure the levels of various hormones regulated by the pituitary gland in the bloodstream. 

These hormones include, but are not limited to:

  • Prolactin
  • Growth hormone
  • Adrenocorticotropic hormone (ACTH)
  • Thyroid-stimulating hormone (TSH)
  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)

Abnormal levels of these hormones can indicate whether the pituitary gland is overproducing or underproducing them, which is a common occurrence in ESS.

Detection of Secondary Conditions: 

Blood tests can also help detect secondary conditions that may be associated with ESS, such as hypothyroidism, adrenal insufficiency, or hyperprolactinemia. 

For instance, elevated prolactin levels could suggest the presence of a prolactinoma, a benign tumor in the pituitary gland that produces excess prolactin.

Assessment of Treatment Efficacy: 

For patients undergoing treatment for ESS, blood tests are routinely used to monitor the effectiveness of hormone replacement therapies or other interventions. By tracking hormone levels over time, healthcare providers can adjust treatment plans to ensure optimal condition management.

Indicators of Potential Complications: 

In some cases, ESS can lead to complications such as panhypopituitarism, where the pituitary gland ceases to produce several essential hormones. Blood tests can alert doctors to the onset of such complications, allowing for prompt and appropriate medical responses.

Guidance for Further Testing: 

If blood tests reveal hormonal abnormalities, they may prompt further testing, such as dynamic function tests, to evaluate the pituitary gland's response to stimuli. These tests can include the insulin tolerance test (ITT), the thyrotropin-releasing hormone (TRH) test, and the gonadotropin-releasing hormone (GnRH) test, among others.

In summary, blood tests for ESS are a cornerstone of diagnosis, providing a detailed picture of pituitary gland function and guiding the clinical approach to treatment. They are essential for confirming the diagnosis of ESS, understanding its impact on the body's hormonal balance, and developing a tailored treatment strategy for affected individuals.

Types of Blood Tests for Empty Sella Syndrome

Hormone Tests

Blood tests are pivotal in diagnosing Empty Sella Syndrome (ESS), which is marked by a shrunken pituitary gland. They measure vital hormones, such as prolactin, impacting fertility; growth hormone, influencing body composition and metabolism; and thyroid-stimulating hormone, governing metabolism and mood. Deviations in hormone levels signal potential ESS, making these tests crucial for diagnostic precision and revealing insights into pituitary gland function and hormonal balance.

Pituitary Function Tests

These tests assess how well your pituitary gland is working. They can help identify any deficiencies or excesses in hormone production.

Understanding Blood Test Results

Interpreting Hormone Levels

Interpreting hormone levels can be tricky. It's not just about whether the levels are high or low, but also about how they compare to the normal range and to each other.

What Abnormal Results Mean

Abnormal results don't automatically mean you have ESS. They could indicate other conditions as well. However, they do signal that further investigation is needed.

Other Diagnostic Methods for Empty Sella Syndrome

Imaging Techniques

Imaging techniques like MRI and CT scans are often used to visualize the pituitary gland and confirm the diagnosis of ESS.

Clinical Evaluation

A thorough clinical evaluation, including a detailed medical history and physical examination, is also essential in diagnosing ESS.

Treatment Options for Empty Sella Syndrome

Medication and Hormone Therapy

Treatment for ESS often involves medication to manage symptoms and hormone therapy to correct any imbalances.


In some cases, surgery may be necessary to relieve pressure on the pituitary gland or to remove a tumor.

Living with Empty Sella Syndrome

Lifestyle Changes

Living with ESS may require some lifestyle changes, such as regular exercise, a healthy diet, and stress management.

Support and Resources

Support groups and resources can be invaluable for people living with ESS. They provide a platform for sharing experiences and learning from others who are going through the same journey.


Empty Sella Syndrome is a complex condition that requires a comprehensive approach to diagnosis and treatment. Blood tests play a crucial role in this process, helping to identify hormonal imbalances and assess pituitary function. With the right care and support, people with ESS can lead fulfilling lives.

Frequently Asked Questions

What labs are done for empty sella syndrome?

Blood tests check hormone levels like thyroid stimulating hormone, cortisol, prolactin, testosterone, and growth hormone to evaluate pituitary function in empty sella syndrome, which involves the sella turcica structure at the base of the skull is abnormally enlarged or flattened.

What hormones are affected by empty sella syndrome?

Empty sella syndrome (ESS) can affect various hormones the pituitary gland produces. Common hormonal abnormalities include deficiencies in thyroid-stimulating hormone (TSH), T3, T4, and elevated prolactin levels. These hormonal imbalances can lead to symptoms such as weight gain and menstrual irregularities, necessitating blood tests for diagnosis and treatment.

What is suggestive of empty sella?

Empty Sella Syndrome (ESS) is a rare condition affecting the pituitary gland, diagnosed through MRI scans. It leads to hormonal imbalances, headaches, and vision problems. Treatment, including hormone replacement or surgery, depends on symptoms. ESS can be primary (often asymptomatic) or secondary, caused by prior injury or treatments. More prevalent in women and older adults, it affects all ages and genders, with an estimated prevalence of around 10%. Its complexity necessitates careful medical evaluation and monitoring.

What kind of doctor treats empty sella syndrome?

Empty sella syndrome is usually treated by an endocrinologist specializing in hormonal disorders. They assess medical history, conduct exams, order imaging tests, and may prescribe medication or recommend surgery. Occasionally, a neurosurgeon may be involved, mainly if surgery is necessary.


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