Issue 1/2026
Apostolov¹, Zh. Trifonov², М.
¹ Second Department of Psychiatry, Faculty of Medicine, Medical University – Varna
² Student, Faculty of Medicine, Medical University of – Varna
Introduction: Empty Sella Syndrome (ESS) is a radiological condition characterized by herniation of cerebrospinal fluid into the sella turcica, resulting in secondary flattening of the pituitary gland. Although often asymptomatic, ESS can be associated with endocrine and neuropsychiatric manifestations. We present a case of a 19-year-old male with ESS and first-episode psychosis (FEP).
Case presentation: The patient was hospitalized for the first time in psychiatric clinic due to acute-onset FEP with paranoid ideation, disorganized thinking, and aggressive behavior. Cranial CT showed a partially empty sella turcica with a pituitary length of 2 mm in the craniocaudal dimension. Endocrine evaluation (FT3, FT4, TSH, morning cortisol) revealed no abnormalities, thus excluding hormonal deficiency as a causative factor.
Conclusion: The co-occurrence of ESS and psychosis highlights potential shared neurodevelopmental vulnerabilities, although a coincidental association cannot be excluded. Complex multidisciplinary assessment is critical for the appropriate follow-up and therapeutic strategy in patients with FEP.
Key words: empty sella syndrome, first-episode psychosis, case report
Address for correspondence:
Apostolov, Zh.
University hospital “St Marina”,
MU “Prof. Dr. Paraskev Stoyanov” – Varna
1 „Hristo Smirnensky“, Blvd.
9010, Varna
e-mail: zhapostolov@gmail.com
Trifonov, M.
e-mail: martin.trifonov02@gmail.com