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Neurology (Expert Forum)
Empty Sella Syndrome CAUSED BY SURGERY
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Empty Sella Syndrome CAUSED BY SURGERY
by cindy__0__0, Sep 27, 1998 12:00AM
In 1994 I had a small pineal gland cyst, I had a pituitary gland of normal size and configuration. My problem was not in my brain. My problem was disc problems in the Cervical and Thoracic areas. After my last surgery, I continued to worsen, this time with symptoms which appeared to be autonomic in nature. I have developed all kinds of strange symptoms, some seeming related to the heart.
A new brain MRI was done. It shows a Empty Sella. Where did my pituitary gland go to? Do surgeries cause your pituitary gland to disappear and present as an Empty Sella? Could this be causing all these autonomic problems?
I have checked your info files and it says that the pituitary gland disappears.
For the heart problems, a cardiologist wants to put me on a calcium channel blocker. Calcium blockers increase ICP, so is it safe for someone that now has a cyst with CSF?
What kind of symptoms can I expect from this surgically induced "empty Sella". Can I do anything to prevent worsening. It is my understanding that the pituitary gland is a very important gland and blood levels of many hormones should be monitered.
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Dear Cindy,
It would be very unusual for a patient to develop an empty sella after surgery for a cervical or thoracic disc. You probably already had some degree of an empty sella that, for whatever reason, wasn't as apparent on the previous MRI. It is difficult to say more without actually seeing the films.
Empty sella syndrome can occur primarily, that is, without a cause, or occasionally it will occur after the transsphenoidal removal of a pituitary tumor. Symptoms can vary from none to headaches to visual deficits and cranial nerve palsies. Most patients with an empty sella can be managed with simple observation. Your condition was probably present, to some degree, on the first MRI. If it is not causing you any problems it may be observed clinically.
The autonomic symptoms could conceivably be from some sort of hypothalamic involvement secondary to the empty sella, but this again would be unusual. Your physician may choose to draw a standard endocrine panel, but it likely will not show significant abnormalities. Beyond this, your 'autonomic' symptoms are difficult to explain.
The pineal cyst doesn't sound like it is giving you any trouble, so you would probably be best served by leaving it alone. One would expect symptoms from hydrocephalus (headaches, nausea, lethargy) if a pineal cyst were large enough to block the flow of CSF from the brain.
You have a few issues that seem to remain unclear to you. Speak to your physician and address each issue individually to come up with a reasonable plan for your care.
Good luck.
