Empty sella is a common radiographic finding — present in up to a third of the general population — and is frequently incidental and asymptomatic. Management hinges on identifying the minority of patients with clinical consequences. When endocrine deficits are present, targeted hormone replacement (cortisol, thyroid hormone, sex steroids) guided by pituitary assessment is essential; when the picture is dominated by raised intracranial pressure (as in the association with idiopathic intracranial hypertension), management is directed at that, with surgery individualized for significant symptoms such as CSF leak or visual compromise. The practical emphasis is on distinguishing an incidental finding from true empty sella syndrome with functional consequences, and screening for the pituitary hormone deficiencies and intracranial-pressure abnormalities that a subset of patients harbor.
Further reading: empty sella and pituitary function reviews; associations with idiopathic intracranial hypertension.