Empty sella syndrome is a collection of neurological, neuroendocrine and neuroophthalmic disorders. Violations in the Turkish saddle directly affect the work of the pituitary gland. The pituitary gland is a gland in the Turkish saddle, the size of a pea, which controls all the glands and processes in the body. Therefore, it is very important not to miss the syndrome of an empty Turkish saddle. How to identify the syndrome of an empty Turkish saddle? What symptoms would indicate this?
Causes of the syndrome of an empty Turkish saddle
Empty sella syndrome develops in people with sagging of the meninges into the sella turcica. From this, the pituitary spreads along the walls and bottom of the Turkish saddle.
The symptom of an empty Turkish saddle is often diagnosed incidentally on an MRI or CT scan. That is, they reveal the vertical size of the pituitary gland less than 3 mm, while dangerous symptoms are not observed.
This symptom can be congenital or develop after surgery on the pituitary gland (pituitary tumor), after exposure to radiation, after taking medications such as somatostatin analogs or dopamine receptor agonists, also after pituitary hemorrhage.
The syndrome of an empty Turkish saddle develops with insufficiency of the diaphragm. This insufficiency can be both congenital and acquired.
Who is at risk for Turkish saddle syndrome
In puberty, during pregnancy, when taking contraceptives for a very long time and in other physiological processes, this is manifested by hyperplasia of the pituitary stalk and the pituitary gland itself. As a result of the enlargement of the pituitary gland, the diaphragm is under excess pressure. In this case, the pituitary diaphragm becomes thinner, and its openings increase.
Therefore, with craniocerebral injuries, damage to the pituitary gland and the Turkish saddle is possible. After all, increased intracranial pressure also changes the pituitary diaphragm, making it thinner. Also, an empty Turkish saddle can occur with neuroinfections and brain tumors. With diaphragm failure, the pia mater settles into the cavity of the Turkish saddle, pressing it against the walls and bottom. The pituitary gland decreases in vertical dimensions. Such a pituitary gland is deformed under the pressure of the cerebrospinal fluid, and the process of expansion of the Turkish saddle begins.
The cause of endocrinological disorders in pathologies in the Turkish saddle is the incorrect control of the hypothalamus in relation to the pituitary gland, since the normal structures of the chiasmal-sellar region of the brain are changed. The cells of the pituitary gland continue to function normally in a state of hypoplasia.
Visual disturbances occur due to tension of the optic nerve as a result of a violation of the anatomical relationship or a violation of the blood circulation in the chiasm.
Clinical manifestations of the syndrome of an empty Turkish saddle
Manifestations of symptoms from the pituitary gland are very diverse and dynamic. Some symptoms are replaced by others, an unexpected onset happens both in remissions and in exacerbations.
Neurological symptoms - appear after stressful situations
- Headache - may vary from mild to unbearable. There is no clear localization.
- Vegetative disorders - pressure rises, chills, shortness of breath, cardialgia, sensations of fear, pain in the extremities and abdomen of a spastic nature, temperature rises, syncope.
- Motivational disorders, emotional and personality disorders.
Endocrine disorders - indiscriminate secretion of various pituitary hormones.
- Hypopituitarism is a reduction or cessation of the production of pituitary hormones.
- Syndrome of hypersecretion of pituitary hormones – acromegaly and Itsenko's disease – Cushing.
- Symptom of metabolic disorders.
- Hyperprolactinemia - sexual dysfunction in men and women.
Visual disturbances – depending on the blood supply in the chiasm and the circulation of cerebrospinal fluid in the arachnoid space.
- Retrobulbar pain with lacrimation, photopsia, diplopia, blurring
- Reduced visual acuity.
- Changes in visual fields (bitemporal hemianopsia, scotomas).
- Swelling and hyperemia of the optic nerve.
Methods for diagnosing Turkish saddle syndrome
At risk for empty sella syndrome are people with traumatic brain injuries in the past and women who have taken contraceptives for a long time, as well as those people who have had a neurosurgical operation. Therefore, one should be attentive to the complaints of such patients.
Survey methods
- Laboratory. Hormonal blood test. If there are no symptoms yet, early diagnosis is to determine the hormone free T4. With a pronounced clinic, a more detailed examination is carried out with the determination of the level of all hormones.
- Instrumental. On MRI and CT, the syndrome of an empty Turkish saddle is indicated by the presence of cerebrospinal fluid in the cavity of the Turkish saddle of the pituitary gland. The pituitary gland itself is located closer to the lower or posterior wall of the Turkish saddle, the size of the pituitary gland is vertical
MRI reveals only indirect facts of the presence of increased pressure inside the skull – dilated liquor-containing spaces and ventricles. You can also use radiography (targeting the area of the Turkish saddle) to diagnose disorders of the Turkish saddle.
Treatment and prevention measures for pathologies of the Turkish saddle and pituitary gland
Treatment is prescribed to balance and correct visual, endocrine and neurological disorders. It is advisable to prescribe analgesic therapy, treatment of autonomic disorders with symptomatic drugs. But the appointment of medications to reduce increased intracranial pressure is inappropriate.
Indications for surgical treatment of empty sella syndrome:
- Sagging into the diaphragmatic foramen at the optic junction with compression of the optic nerve.
- Leakage of cerebrospinal fluid through the thinned bottom of the Turkish saddle of the pituitary gland.
Operation – tamponade of the Turkish saddle in the pituitary gland, transsphenoidal fixation of the chiasm (chiasmopexy).
Thus, in the presence of the syndrome of an empty Turkish saddle, it is impossible to cure a person. It is only possible to correct his condition with medicines. Therefore, the prevention of violations of the Turkish saddle and pituitary gland is so important. To do this, head injuries should be avoided whenever possible, and for women, long-term use of contraceptives.
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