Dear Dr. Gott: My 45-year-old daughter has had a headache every day for the past six months and is now being treated for migraines. She recently had an MRI of her brain, which showed that her pituitary gland is empty. What in the world does that mean? Please help me to understand.
Dear Reader: I believe your daughter is suffering from empty sella syndrome. This is a condition in which the pituitary gland shrinks or becomes flattened and does not show up on MRI scans.
The pituitary gland produces several important hormones that control other glands within the body. It is vital to the maintaining normal function of the ovaries, testicles, thyroid and adrenal glands. The ovaries produce the female hormone estrogen. The testicles produce the male hormone testosterone. The thyroid gland produces several hormones that aid metabolism. The adrenal glands also produce several life-sustaining hormones, such as cortisol, which aid stress responses and have many other functions.
There are two forms of empty sella syndrome: primary and secondary. Primary occurs when a hole develops in the pituitary gland covering. This allows fluid to get in and press on the gland. Secondary occurs when the gland has become damaged. This is often the result of radiation therapy, a tumor or surgery. It may also be the result of a condition known as pseudotumor cerebri, which causes intracranial pressure to increase, such as is seen with a tumor but without the actual tumor. This form is most commonly seen in obese women.
Primary empty sella syndrome often has no symptoms and doesn’t cause a loss of pituitary function. If symptoms are present, they may include erectile dysfunction, low libido, irregular or absent menstruation and occasional symptoms owing to high prolactin levels. Prolactin is a hormone responsible for milk production and breast development in women; there is no known function in men. High levels can cause impotence and enlarged breasts in men, and infertility, irregular menstrual periods and breast-milk production unrelated to childbirth in women.
Secondary sella syndrome may cause symptoms owing to partial or complete loss of pituitary-gland function (hypopituitarism). These symptoms vary depending on which hormones have been affected but may include fatigue, thirst, excess urination, low blood pressure, loss of appetite, constipation, muscle weakness, headaches, nausea, weight gain or loss, hoarseness, visual disturbances, a low tolerance for stress, abdominal discomfort, loss of pubic and underarm hair, sensitivity to cold/difficulty staying warm, facial puffiness, joint stiffness and more.
Primary has no specific treatment. If prolactin levels are high and interfering with the function of the ovaries or testes, medication may be prescribed to bring the levels back within range. Treatment of secondary empty sella syndrome involves replacing the hormones that are deficient and, if possible, treating the condition that caused the destruction of the gland.
If your daughter has been suffering from chronic headaches, it may be a sign that her pituitary gland has been damaged, leading to hypopituitarism. If this is the case, she should undergo testing to determine what caused the damage. She might benefit from hormone-replacement therapy. She should be under the care of an endocrinologist (gland specialist) who can order any necessary testing and provide appropriate treatment options.
To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.
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