The most common causes of vacuolation saddle are postpartum hemorrhage and multiple pregnancies in women, and in some men for unknown reasons. Vacuolar saddle does not heal on its own because the cerebrospinal fluid has infiltrated into the pituitary fossa. Whether vacuolar saddle causes alterations in pituitary function is determined by testing the hormones of the adrenal, thyroid and gonadal axes. If there is a deficiency of the relevant hormones, hormone replacement therapy can be administered to restore the patient to normal physiological function, such as prednisone, levothyroxine sodium tablets, and sex hormone replacement to correct hypopituitarism caused by vacuolated saddles. Some vacuolated saddles do not result in decreased pituitary function, and regular follow-up may be an option at this time.