Mysterious disease: empty turkish saddle syndrome

The pathology of the pituitary gland is one of the most dangerous groups of endocrinological diseases, since it is the hormones of the pituitary gland that control the normal functioning of all  other organs of the endocrine system. In modern medicine and  endocrinology, in particular, the issue of pituitary neoplasms is often raised, which, through pressure on the endocrine organ, cause significant disruptions in its work and, consequently, the functioning of the entire endocrine system.

However, 10% of the entire pathology of the pituitary gland is such a pathological condition as the syndrome of an empty Turkish saddle. Its often accidental discovery confuses many doctors. To avoid such situations, medical practitioners must be aware of even the rarest diseases of the endocrine system.

What does the diagnosis of empty sella syndrome mean

Syndrome of an empty Turkish saddle – This is a symptom complex of neurological, neuroendocrine and neuroophthalmic disorders that develop against the background of the pathology of the pituitary diaphragm and its compression by the meninges penetrating into the cavity of the Turkish saddle. The meninges produce a compression effect on the pituitary gland, as a result of which it seems to spread out along the bottom and walls of the Turkish saddle. However, compression of the pituitary cells does not interfere with their normal function, and clinical symptoms result from disruption of normal anatomical connections between the hypothalamus and the pituitary gland. There is a primary emerging syndrome of an empty Turkish saddle, in which the pathology develops & nbsp; without the influence of any previous diseases of the pituitary gland, and secondary – arising against the background of such conditions,

Causes of the syndrome of an empty Turkish saddle

A prerequisite for the formation of the empty sella turcica syndrome is the presence of a defect in the diaphragm, which allows the meninges to penetrate into the sella turcica. Diaphragm insufficiency can be either congenital or acquired. In the second case, the pathology occurs as a result of damage to the diaphragm during surgical interventions on the brain or under the influence of certain medications, for example, with long-term use of oral contraceptives. Tumors or hemorrhages in the brain lead to an increase in intracranial pressure, resulting in an increased risk of dilatation of the aperture of the sella turcica. Penetrating into the sella turcica, the meninges cause a decrease in the vertical size of the pituitary gland and press it against the bottom and walls of the sella turcica.

Clinical presentation of empty sella syndrome

The clinical picture of the syndrome of an empty Turkish saddle in most cases is absent or can proceed in the form of spontaneous exacerbations and remissions or a chaotic succession of symptoms. It all depends on how exactly the pituitary gland was deformed and the pathology of which structures it entailed. The following groups of symptoms of an empty Turkish saddle are distinguished:

neurological symptoms: headaches, disturbances in the emotional state and behavioral reactions of the patient, pressure surges, chills, shortness of breath, temperature fluctuations, pain in the heart, abdomen, limbs and other autonomic disorders;
endocrine symptoms: hyperprolactinemia, hypopituitarism, pituitary hormone hypersecretion syndromes, symptoms of diabetes insipidus and other metabolic disorders;
Visual disturbances: they occur as a result of tension of the optic nerves due to deformation of the pituitary gland, and are manifested by the occurrence of retrobulbar pain with lacrimation, diplopia and photopsia, decreased visual acuity, changes in visual fields, as well as edema and hyperemia of the optic disc.

Methods for diagnosing empty sella syndrome

Diagnosis of the syndrome of an empty Turkish saddle is based on instrumental research methods. Since the symptoms of the disease may be completely absent, often the pathology is detected completely by accident. Laboratory studies consist in studying the state of the hormonal background in the event of endocrine symptoms of the Turkish saddle syndrome. Computed and magnetic resonance imaging, as well as targeted radiography of the skull, are the most informative methods for diagnosing empty sella turcica syndrome. A deformed pituitary gland is visualized, shifted to the posterior or lower wall of the sella turcica with a significantly reduced vertical size. It is often possible to detect cerebrospinal fluid in the saddle cavity and signs of intracranial hypertension –

Conservative and surgical treatment of empty sella syndrome

Empty sella syndrome can be treated conservatively or surgically. Drug therapy is carried out with the aim of correcting endocrinological disorders, as well as for the purpose of pain relief and symptomatic treatment of autonomic disorders. Drug correction of intracranial hypertension does not make sense, since the root cause of this condition has not been eliminated. Surgical treatment of the syndrome of an empty sella turcica is required in the presence of sagging of the optic chiasm into the opening of the diaphragm and subsequent compression of the optic nerves, as well as in the leakage of cerebrospinal fluid through the thinned bottom of the sella turcica. Transsphenoidal fixation of the chiasm and tamponade of the Turkish saddle are performed.