How does empty sella syndrome lead to weight gain?

How does empty sella syndrome lead to weight gain?

Empty Sella syndrome can cause weight gain, especially in women, and hypertension, highlighting the importance of monitoring and managing these conditions in individuals diagnosed with empty Sella syndrome. This Empty-sella syndrome occurs when the pituitary gland is flattened or shrinks, leading to hormone imbalances

Obese women with unexplained weight gain may have undiagnosed empty sella syndrome. While less common, some patients with empty sella syndrome experience weight loss. Recognizing this connection is important for the diagnosis and treatment of the condition.

Empty Sella Syndrome and Weight Gain

What is Empty Sella Syndrome?

Empty Sella Syndrome (ESS) is a condition in which the pituitary gland shrinks or becomes flattened, often leading to a situation where the gland cannot be observed in an MRI, giving the appearance of an "empty saddle." 

This condition can be primary, occurring when one of the layers covering the outside of the brain protrudes into the saddle and pressures the pituitary, or secondary, resulting from damage to the pituitary due to factors like tumors, radiation therapy, surgery, or trauma.

Empty sella syndrome and weight gain symptoms

Empty Sella Syndrome can manifest through a variety of symptoms, which may vary significantly among individuals.

Some of the common symptoms associated with Empty sella syndrome include:

Fatigue and Weakness

Many patients with Empty Sella Syndrome report a persistent sense of fatigue, cold intolerance, and general weakness that are not alleviated by rest. This could be due to the pituitary gland's reduced functioning, which affects the body's energy levels.

Hormonal Imbalances and Weight Fluctuations

Unexplained weight gain is a typical symptom of Empty Sella Syndrome, especially among middle-aged women. This gain can be rapid and may be accompanied by other signs of hormonal imbalance, such as cold skin, constipation, and dry skin. These symptoms suggest a deficiency in hormones like ACTH or TSH, which are responsible for regulating metabolism and body weight.

Reproductive Health Issues

Irregular menstrual cycles or infertility can be a major concern for women with Empty Sella Syndrome. The loss of menstrual regularity or the inability to conceive can be distressing and is often linked to hormonal imbalances. Additionally, some women may experience galactorrhea, which is the production of breast milk outside of childbearing or breastfeeding.

Hair Loss

Patients may notice a decrease in facial or pubic hair growth, which can be a direct result of hormonal changes, particularly those affecting sex hormone levels.

Sexual Dysfunction

Both men and women with Empty Sella Syndrome might experience a decreased sex drive, while men may also face erectile dysfunction. These symptoms are typically due to altered levels of hormones like prolactin, LH, and FSH, which play a crucial role in sexual function and libido.

Additional Symptoms

Headaches and visual disturbances are also common in Empty Sella Syndrome, potentially indicating increased intracranial pressure or other complications. High blood pressure and other symptoms may arise depending on the extent of the pituitary gland's involvement.

It's important to note that Empty Sella Syndrome can also be associated with other symptoms, such as headaches, high blood pressure, and visual disturbances, depending on the individual and the extent of pituitary gland involvement. 

Diagnosis and treatment of Empty sella syndrome typically involve addressing the specific symptoms and hormonal imbalances present in each individual.

Empty Sella Syndrome and Weight Gain

Weight gain is not a commonly reported symptom of Empty Sella Syndrome itself. However, certain pituitary hormone deficiencies associated with ESS can contribute to weight gain:

  • Hypothyroidism (TSH deficiency): Can cause weight gain, fatigue, cold intolerance, constipation, etc.
  • Growth hormone deficiency: Can lead to increased fat mass and weight gain.
  • Hypocortisolism (ACTH/cortisol deficiency): May cause weight gain, fatigue, muscle weakness.
  • One study found up to 48% of Empty sella syndrome patients had TSH/thyroid hormone deficiencies, which could contribute to weight gain.
  • However, rapid significant weight loss has also been reported as an unusual presentation in a case of ESS with pituitary hormone deficiencies.

While Empty Sella Syndrome itself does not directly cause weight gain, the associated pituitary hormone deficiencies like hypothyroidism, growth hormone deficiency, and hypocortisolism can potentially lead to weight gain in some patients with Empty sella syndrome, especially if the deficiencies are undiagnosed/untreated.

How Empty Sella Syndrome Can Cause Weight Gain

The Relationship Between Empty Sella Syndrome and Weight Gain

Empty Sella Syndrome can indirectly lead to weight gain by affecting the production of several hormones from the pituitary gland. The pituitary gland is often called the "master gland" because it produces hormones that regulate many essential bodily functions, including metabolism. 

When Empty Sella Syndrome compromises the pituitary gland, it can lead to deficiencies in one or more of these hormones, and these deficiencies can influence weight gain in different ways:

Thyroid-stimulating Hormone (TSH)

A crucial hormone produced by the pituitary gland, TSH stimulates the thyroid gland to produce thyroid hormone. Thyroid hormone plays a critical role in regulating metabolism, the rate at which your body burns calories for energy. 

If Empty sella syndrome reduces TSH production, the thyroid gland doesn't produce enough thyroid hormone, leading to a condition called hypothyroidism. 

Hypothyroidism is a well-known cause of weight gain because it slows down metabolism, making it harder for the body to burn calories and leading to an accumulation of unused calories as fat.

Other Hormones: In addition to TSH, deficiencies in other hormones produced by the pituitary gland can also contribute to weight gain in some people with Empty sella syndrome. These hormones include:

  • Growth hormone: Growth hormone helps regulate metabolism, body composition, and fat storage. A growth hormone deficiency can lead to decreased muscle mass and increased fat storage, contributing to weight gain.
  • Cortisol: Cortisol is a stress hormone produced by the adrenals under the regulation of the pituitary gland. Cortisol helps regulate blood sugar levels and metabolism. In chronic stress situations, cortisol levels can remain elevated, leading to increased appetite, weight gain, and fat storage around the abdomen. People with Empty sella syndrome may have difficulty regulating cortisol production, potentially contributing to weight gain.
  • Sex hormones (estrogen, testosterone): Sex hormones regulate metabolism and fat distribution. Deficiencies in sex hormones, which can occur in Empty sella syndrome, can lead to changes in body composition and fat distribution, sometimes manifesting as weight gain.

Managing Weight Gain with Empty Sella Syndrome

Focus on these key areas:

1. Address the Underlying Cause
  • Hormone evaluation: Consult an endocrinologist to check for hormone deficiencies and get treatment as needed.
2. Healthy Lifestyle
  • Balanced diet: Emphasize whole foods and consult a dietitian for guidance.
  • Regular exercise: Aim for at least 150 minutes of moderate-intensity activity weekly.
  • Stress management & quality sleep: Practice relaxation techniques and aim for 7-8 hours of sleep.
3. Additional Considerations
  • Overweight and Obesity: If obese, medically-supervised weight loss may help ESS symptoms.
  • Medications: Review any medications with your doctor that might contribute to weight gain.
4. Ongoing Monitoring
  • Regular checkups: See your doctor and endocrinologist to monitor hormone levels and weight.
  • Open communication: Discuss any health changes with your medical team.
  • Individualized approach: Your plan will be based on your specific needs.
  • Patience: Weight management takes time.
  • Teamwork: Work closely with your doctor, endocrinologist, and maybe a dietitian.

Is weight gain associated with hormonal changes in Empty sella syndrome?

Yes, being overweight can be associated with hormonal changes in Empty Sella Syndrome. The pituitary gland, which can be compressed in Empty Sella Syndrome, is responsible for regulating various hormones in the body.

The most common hormonal issue in ESS is a lack of Thyroid-Stimulating Hormone (TSH), leading to hypothyroidism. This means your thyroid isn't producing enough hormones to maintain a healthy metabolism, making weight gain more likely.

Empty Sella Syndrome can cause imbalances in various hormones, including growth hormone, cortisol, and sex hormones. These imbalances can hinder weight management efforts significantly and even disrupt thyroid hormones.

Not everyone with Empty Sella Syndrome experiences weight gain, and other factors can play a role. Consult your doctor if you're concerned about weight gain and have ESS.

How Is Empty Sella Syndrome Diagnosed?

Empty Sella Syndrome is usually diagnosed through:

  • Magnetic Resonance Imaging (MRI) is the primary tool for diagnosing ESS. It shows the size and shape of the sella turcica and pituitary gland.
  • Computed Tomography (CT) Scan: A possible alternative if MRI isn't available.
Hormone Testing:
  • Your doctor may order blood tests to check your pituitary gland's function, looking for deficiencies in hormones like thyroid hormone, growth hormone, cortisol, and sex hormones.
Other Examinations (Less Common):
  • Visual Field Test: To check if your vision is affected.
  • Lumbar Puncture (Spinal Tap): Rarely, it might be used to check for high pressure in the brain.

Empty Sella Syndrome is often found by chance during brain scans done for other reasons. Discuss any potential symptoms with your doctor. They'll decide if an MRI and other tests are needed.

Difference Between "Empty Sella" and "Empty Sella Syndrome"

Empty Sella
  • A finding on imaging scans: The sella turcica (where the pituitary gland sits) looks "empty" because it's filled with fluid.
  • Doesn't always cause symptoms: Many people have an empty sella with no problems.
Empty Sella Syndrome
  • A medical condition: An empty sella plus symptoms of pituitary gland dysfunction (headaches, hormone inequalities, etc.).
Empty sella is the image on a scan, ESS is the diagnosis when that image causes problems.

Empty sella syndrome and weight gain treatment

Treatment for Empty Sella Syndrome (ESS) varies depending on whether the condition is primary or secondary, and the presence and severity of symptoms.

Primary Empty Sella Syndrome (PES)

For patients with PES, which has no identified underlying cause, treatment is often supportive and focuses on managing any symptoms that may arise. This can include pharmacologic therapies such as hormone replacement if the patient experiences hormonal deficiencies due to the compression of the pituitary gland by cerebrospinal fluid (CSF) within the sella turcica.

Secondary Empty Sella Syndrome (SES)

In cases of SES with an identifiable etiology, such as cerebral trauma or postpartum pituitary necrosis, treatment may involve addressing the underlying cause. For symptomatic patients, management can vary from pharmacologic treatments, including growth hormone replacement, to surgical interventions. Surgical options may include procedures like lumbar peritoneal shunt to manage symptoms related to increased intracranial pressure or chiasmapexy to address optic nerve herniation.

Hormonal Replacement Therapy

Hormonal replacement therapy is a critical component of the treatment plan for patients experiencing hormonal deficiencies. This may start with hydrocortisone, followed by thyroid hormone supplementation and other hormones as needed based on the patient's specific deficiencies.

Surgical Treatment

Surgical treatment is considered for SES patients who have severe symptoms that do not improve with conservative management. Options include chiasmapexy for optic nerve herniation and lumbar–peritoneal shunt for managing symptoms related to CSF dynamics.

Conservative Follow-up

Patients with secondary ESS without severe symptoms may be followed up conservatively, with surgical treatment applied if symptoms deteriorate or do not improve[1].
In summary, the treatment for ESS is tailored to the individual's symptoms and the underlying cause of the syndrome. It can range from supportive care and hormonal replacement therapy to more invasive surgical interventions for severe cases.

Conclusion: Empty Sella Syndrome and Weight Gain

Empty Sella Syndrome (ESS) can indirectly contribute to weight gain by disrupting hormone production, most commonly causing hypothyroidism (low thyroid function).
Not everyone with Empty Sella Syndrome experiences weight gain, and other factors can play a role.

Consult your doctor if you have Empty Sella Syndrome and are concerned about weight gain. They'll evaluate your hormone levels and other potential contributing factors.

Regardless of whether weight gain is a direct consequence of ESS, proper management of the condition is crucial:
  • Treatment of any hormone deficiencies
  • Adoption of healthy lifestyle habits for weight management
  • Ongoing monitoring by your healthcare team
Empty Sella Syndrome (ESS) can lead to weight gain. If you have ESS, monitor your weight and work with your doctor to manage it. Women with ESS may also experience headaches or changes in bodily functions. Discuss any unusual symptoms with your doctor to develop a personalized health plan.


What hormones are affected by empty sella syndrome?

Thyroid hormone, growth hormone, sex hormones, and cortisol can all be affected.

What are the severe symptoms of empty sella syndrome?

Severe headaches, vision problems, and significant hormone deficiencies are considered severe.

Can you lose weight with empty sella syndrome?

Yes, with treatment for hormonal imbalances and a healthy lifestyle, weight loss is possible.

Can you get disability for empty sella syndrome?

Disability depends on the severity of symptoms, complications, and their impact on daily life.

Can empty sella cause Cushing's?

Rarely, empty sella can occur alongside Cushing's disease, but it is not a direct cause.



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