The symptoms of empty sella syndrome may vary from one person to another and depends on the underlying cause. In most cases, especially in individuals with primary empty sella syndrome, there are no associated symptoms (asymptomatic). Often, empty sella syndrome is discovered incidentally on CT or MRI examination when individuals are being evaluated for other reasons.

The most common symptom potentially associated with empty sella syndrome is chronic headaches. However, it is unknown whether headaches develop because of empty sella syndrome or are simply a coincidental finding. Many individuals with empty sella syndrome have high blood pressure (hypertension), which can itself cause headaches if severe.

In rare cases, individuals with empty sella syndrome have developed increased pressure within the skull (benign intracranial pressure), leakage of cerebrospinal fluid from the nose (cerebrospinal rhinnorhea), swelling of the optic disc due to increased cranial pressure (papilledema), and abnormalities affecting vision such as loss of clarity of vision (visual acuity).

In the empty sella syndrome, the function of the pituitary gland is usually not affected. It is often not well seen on imaging, but is otherwise perfectly functional. The pituitary is a small gland located near the base of the skull that stores several critical hormones and releases them into the bloodstream as needed by the body. These hormones regulate many different bodily functions. Although a rare occurrence, some abnormal or decreased pituitary function can occur (hypopituitarism) in the setting of empty sella. A specific finding in some individuals with empty sella, including children, has been isolated growth hormone deficiency.

Individuals with secondary empty sella syndrome are more likely to develop abnormalities affecting vision and decreased function of the pituitary because the underlying cause of their empty sella (e.g.treated pituitary tumor or trauma) result in these other associated problems.