Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the recommended treatment approach for empty sella syndrome?

1. Medication therapy

2. Nothing

3. Surgery to remove the sella

4. Hormonal replacement therapy

The correct answer is: Nothing

In the context of empty sella syndrome, the recommended treatment approach is often to do nothing, especially in cases where the condition is asymptomatic. Empty sella syndrome occurs when the sella turcica, a cavity at the base of the skull that contains the pituitary gland, appears to be empty on imaging studies, often due to the flattening or herniation of the dura mater. This may be an incidental finding and is commonly without significant clinical manifestations. If patients do not exhibit symptoms related to pituitary hormone deficiency—such as headaches, visual disturbances, or hormonal imbalances—monitoring without intervention is typically adequate. Most individuals with empty sella syndrome lead normal lives without the need for medical or surgical intervention. In contrast, medication therapy or hormonal replacement therapy may be necessary only if the patient demonstrates specific symptoms or hormonal deficiencies stemming from pituitary dysfunction. Surgery to remove the sella is not a standard approach because it involves risks and is generally unnecessary. Hence, for the majority of cases, particularly those that are asymptomatic, the recommendation is simply to observe and provide reassurance to the patient without active treatment.