Empty Turkish Saddle - Symptoms, Treatment And Prevention

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Empty Turkish Saddle

The formation in the form of a depression, which forms in the body of the sphenoid bone of the human skull, is called the Turkish saddle. The condition in which the cavity between the soft and arachnoid membranes of the brain is invaginated into the intrasellar region and the pituitary gland is compressed due to insufficiency of the diaphragm of the sphenoid bone is called the empty Turkish saddle (PTS).

This lesion can be primary, if it is caused by physiological processes, or secondary, when it is detected after irradiation of the chiasmatic-sellar region or surgery. With a secondary empty Turkish saddle of the brain, the diaphragm of the depression itself may not be disturbed.

For the first time, the term PTS was proposed by the pathologist W. Bush in 1951, when he studied autopsy material of 788 deceased people and found that the diseases that led to death were not always associated with pituitary pathology.

The pathologist revealed an almost complete absence of the sella turcica diaphragm in 40 cases, instead there was a pituitary blooming at the bottom of the formation, resembling a thin layer of tissue. Then Bush proposed a classification of the forms of the syndrome, depending on the type of structure of the diaphragm and the volume of intrasellar cisterns located between the medulla oblongata and the cerebellum, which was modified by T. F. Savostyanov only in 1995.

Predominantly, the syndrome of the emerging empty Turkish saddle is detected in multiparous women over the age of 40 (in 80% of cases), almost 75% of patients are obese.

The causes of the disease can be menopause, hyper- and hypothyroidism, pregnancy and galactorrhea-amenorrhea syndrome.

Symptoms of an empty Turkish saddle

In most cases, the condition is asymptomatic, in 70% of patients there is a severe headache, which causes the need for an X-ray of the skull, through which an empty Turkish saddle of the brain is detected.

Possible manifestations of the syndrome are decreased visual acuity, bitemporal hemianopsia, and narrowing of the peripheral fields. In the medical literature, descriptions of optic nerve edema in PTS are increasingly common.

In an increasing number of patients, the forming empty sella turcica is found in combination with hypersecretion of tropic hormones and pituitary adenoma.

Under the influence of pulsation of cerebrospinal fluid, in rare cases, the bottom of the sella turcica ruptures, which results in a rare complication - rhinorrhea, requiring immediate surgical intervention. Against the background of the syndrome of the empty sella turcica, there is a connection between the sphenoidal sinus and the suprasellar subarachnoid space, which significantly increases the risk of meningitis.

Symptoms of an empty Turkish saddle can be endocrine disorders, the manifestations of which are changes in the tropic functions of the pituitary gland.

According to previous studies that used radioimmunoassay methods and stimulation tests, a high percentage of patients with subclinical forms of hormone secretion disorders were identified.

Thus, in 8 out of 13 patients, the response of growth hormone secretion to stimulation by insulin hypoglycemia was reduced, and in 2 out of 16 patients inadequate changes in adrenocorticotropic hormone, which is a stimulator of the adrenal cortex, were found.

Also, symptoms of an empty Turkish saddle are an increase in the peptide hormone prolactin, motivational and emotional-personality disorders, autonomic disorders accompanied by chills, headache, without clear localization, a sharp increase in blood pressure and temperature, cardialgia, fainting, pain in the extremities and abdomen, shortness of breath and the occurrence the patient has a feeling of fear.

It is not excluded the development of liquorrhea, memory impairment, stool disorders, difficulty breathing, pain in the heart, fatigue and decreased performance.

Diagnostics of an empty Turkish saddle

An ophthalmological examination is of paramount importance for the diagnosis and subsequent tactics of treating an empty Turkish saddle. If a threat of complete loss of vision is identified, the patient needs urgent surgical intervention.

No less important are laboratory tests, through which the level of pituitary hormones in the blood plasma is determined. Also, to diagnose the disease, an overview X-ray and a targeted X-ray of the Turkish saddle area, MRI and CT of the head are needed.

Prevention and Treatment of Empty Turkish Saddle

Disease prevention measures include:

• Avoiding traumatic situations, thrombosis, pituitary and brain tumors;
• Full treatment of inflammatory, including intrauterine, diseases.

If a primary PTS syndrome is found in a patient, treatment is usually not prescribed; the main task of the doctor is to convince the patient that the disease is absolutely safe. In some cases, hormone replacement therapy is necessary, while with a secondary empty Turkish saddle, it is needed in each case.

Surgical intervention for primary PTSD syndrome is indicated only in two cases, namely:

• When the optic intersection sags into the aperture of the diaphragm of the Turkish saddle, due to which the fields are disturbed and the nerves of vision are compressed;
• When cerebrospinal fluid flows out of the nose through the exhausted bottom of the sella turcica;

With secondary syndrome of an empty Turkish saddle, a neurosurgeon, depending on the indications, may prescribe treatment for a pituitary tumor.

Empty Turkish saddle is a condition in which the pituitary gland is compressed and the cavity between the soft and arachnoid membranes of the brain is invaginated into the intrasellar region. According to statistics, the disease develops against the background of obesity, menopause, pregnancy, hyper- and hypothyroidism. Treatment of primary and secondary syndrome is prescribed by a neurosurgeon on an individual basis, depending on the indications.

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The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!