The pituitary is an endocrine gland beneath the brain that secretes hormones (anterior and posterior lobes) regulating growth, metabolism, reproduction and water balance. The sella (sella turcica) is a saddle-shaped bony depression in the sphenoid bone that houses and protects the pituitary. In short: the pituitary is the soft-tissue hormone-producing organ; the sella is its surrounding bony cavity.

A CT scan can image the pituitary gland, but its small size and soft-tissue detail make CT less sensitive than MRI for detecting pituitary abnormalities, especially microadenomas. CT is useful when MRI is contraindicated or to assess bone detail, calcification, or acute hemorrhage. For most pituitary tumors and detailed evaluation, MRI with contrast is the preferred test.

Empty sella is a radiological finding where the sella turcica appears partly or completely filled with cerebrospinal fluid, flattening the pituitary gland. Many people have normal pituitary function and no symptoms, but some develop hormonal deficiencies (hypopituitarism), headaches, or visual changes. Evaluation includes endocrine testing and imaging; treatment addresses any hormone deficits or complications.

The best imaging for the pituitary gland is contrast-enhanced MRI with a dedicated pituitary protocol: thin-slice coronal and sagittal T1-weighted images obtained before and after gadolinium, often with dynamic contrast sequences to improve microadenoma detection and assess parasellar extension. CT is less sensitive and is used only when MRI is contraindicated or to evaluate bony anatomy of the sella.

Headache is the most common indicator of a pituitary tumor, often with visual disturbances. As the tumor enlarges it can compress the optic chiasm, producing classically bitemporal hemianopia (loss of peripheral vision). Other signs include hormonal changes—menstrual irregularities, erectile dysfunction, or Cushingoid features—but headache with progressive visual field loss is the hallmark prompting evaluation.

Pituitary problems can cause headaches, vision changes (especially loss of peripheral vision), fatigue and unexplained weight changes. Hormone imbalances lead to menstrual irregularities, infertility, decreased libido or erectile dysfunction, cold intolerance, hair thinning, low blood pressure and mood changes. Other signs include nausea, abnormal breast milk discharge and excessive thirst with frequent urination (diabetes insipidus). Seek medical evaluation if these occur.