What is the history of Empty Sella Syndrome?

Empty Sella Syndrome (ESS) was first identified in the early 20th century, though it remained largely a radiological curiosity until the advent of advanced imaging. Today, Empty Sella Syndrome is understood as a spectrum ranging from incidental findings on MRI to symptomatic cases involving hormonal or vision-related concerns.

When was Empty Sella Syndrome first described?

The concept of an "empty" sella turcica—the bony structure housing the pituitary gland—was first documented in the early 1900s during autopsy studies. However, the term Empty Sella Syndrome was not formally introduced until 1951 by W.G. Busch, who described the condition during post-mortem examinations. For decades, it was considered a rare anatomical anomaly rather than a clinical diagnosis.

How has our understanding of Empty Sella Syndrome evolved?

In the mid-20th century, Empty Sella Syndrome was frequently misdiagnosed or overlooked because clinicians lacked the tools to visualize the brain in vivo. The introduction of pneumoencephalography—an invasive and painful procedure—allowed early researchers to see the "empty" space, but it wasn't until the invention of the MRI in the 1970s and 80s that we realized Empty Sella Syndrome is actually quite common. We now distinguish between primary Empty Sella Syndrome (often associated with obesity, hypertension, or idiopathic intracranial hypertension) and secondary Empty Sella Syndrome (caused by prior surgery, radiation, or pituitary tumors).

What were the historical misconceptions about the condition?

Early medical literature often assumed that an "empty" sella meant the pituitary gland was absent or non-functional. We now know that in most cases of Empty Sella Syndrome, the pituitary gland is simply flattened against the floor of the sella and remains fully functional. Modern endocrinology has corrected the historical view that all patients with this radiographic finding require aggressive intervention.

Key milestones in the history of the condition

• 1951: W.G. Busch provides the first comprehensive description of the sella turcica morphology.


• 1968: The term "Empty Sella Syndrome" is popularized by Kaufman and colleagues.


• 1980s: The widespread adoption of MRI transforms the diagnosis, shifting it from an autopsy finding to a common clinical observation.


• Modern Era: Recognition of the link between Empty Sella Syndrome and idiopathic intracranial hypertension (IIH) leads to more targeted patient care.

Next steps

• Consult an endocrinologist to assess pituitary hormone function if you have been diagnosed with Empty Sella Syndrome.


• Speak with a neuro-ophthalmologist if you experience vision changes or persistent headaches.


• Join the DiseaseMaps.org community to connect with other patients and share experiences.

Medical disclaimer: This information is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment.

References

• NIH Genetic and Rare Diseases Information Center (GARD): Empty Sella Syndrome


• Orphanet: Primary Empty Sella Syndrome


• National Institute of Neurological Disorders and Stroke (NINDS)


• OMIM (Online Mendelian Inheritance in Man)