Causes of the syndrome of the empty Turkish saddle. Diagnosis, treatment

The emergence of the syndrome of the empty Turkish saddle has many causes and explanations. The thing is that, when called empty, it can not be a priori hollow. In connection with a significant decrease in the volume of such a gland as the pituitary gland, the space once occupied by it passes over to the cerebrospinal fluid and other cerebral membranes.

So it turns out that the pituitary gland is practically not visible on X-ray photographs, and only spinal fluid and the membrane are visually available. Therefore, such a space is called empty. Therefore, this condition is detected by specialists in MRI or CT of the head. Neuropathologists and neurosurgeons then develop a treatment regimen and, in accordance with it, determine further actions.

Where is the Turkish saddle?

The natural location of the Turkish saddle is the depression of the saddle shape in the bone structure of the base of the human skull . It is part of the sphenoid sinus, namely the portion of the upper wall. It has rather small dimensions both in length (about 10 mm) and in height (7-13 mm). The cavity of the Turkish saddle, in which the pituitary gland is located, is called the pituitary fossa. From the subarachnoid space it is separated by a diaphragm - a solid shell of the brain. Through a tiny hole in the diaphragm passes the so-called pituitary leg, which has a connection with the hypothalamus.

Research in this field

In the middle of the twentieth century, the concept of "empty Turkish saddle" became known throughout the world. What this means, could accurately determine the American pathologist Bush in the early 50's. During long, lengthy studies, he was able to detect the absence or underdevelopment of the same diaphragm in half of the deceased. Studying the autopsy material of almost 800 corpses, he was able to conclude that not in all lethal cases, the pathological conditions of the gland became the main factor. Bush noticed that the pituitary gland had significantly changed in the pituitary fovea, acquired a diffuse form and had the appearance of a thin layered tissue.

The Russian researcher Savostyanov in 1995 modified Bush's proposed classification of syndromes that differ in type of diaphragm, the volumes of intrasellar cisterns formed between the cerebellum and the medulla oblongata. At the same time, scientific findings spoke of the following: in 8 out of 10 women over the age of forty, giving birth more than once, pathology is formed, and the symptoms of the empty Turkish saddle syndrome begin to appear. In addition, more than two thirds of sick women suffered from obesity of various degrees during their lifetime. Within a few years the scientists managed to link the pathology with clinical manifestations, to identify the primary and secondary nature of the syndrome of the empty Turkish saddle.

Forms of the disease

Due to the possible division of the disease into the primary and secondary forms, it is possible for the patient to determine the most appropriate treatment option. In practice, this is of great importance when predicting the course of the disease.

The primary syndrome of the empty Turkish saddle, the symptoms of which are manifested by increased intracranial pressure, practically does not affect the state of the pituitary gland. Despite the minimal "suffering" of the gland, there is a certain defect in the diaphragm. Further deforming effect on the pituitary gland is reflected in its volume, reducing it, after which the space of the Turkish saddle is occupied by the lowered cerebral membranes and liquid (liquor).

Neurologic symptoms with secondary disease are more pronounced. Since the gland itself is the first to fall into the gland itself, it often requires immediate surgical treatment, radiotherapy and the use of a variety of medications to avoid hemorrhage. It follows that the most dangerous is the secondary syndrome of the empty Turkish saddle. The causes of the origin of the disease lie in many factors that need to be considered in detail.

Probable circumstances of the onset of the disease

In the first place, the risk group should include people who have a hereditary predisposition to the occurrence of this problem. From biological parents, children often get an immature diaphragm, which is an underdeveloped, non-integral shell. Basically, even in the prenatal period, the fetal brain in the womb of the mother can be formed with the presence of defects under the negative influence of environmental factors. The most dangerous elements are radiation, environmental insecurity, modified food products, stresses experienced by a future mother, poor quality of drinking water and much more.

The consequences of increased intracranial pressure

Dangerous complications of some diseases have a significant effect on the appearance of this factor. Increase intracranial pressure may because of:

• Suffered skull injuries, bruises, concussions;
• Hypertension and other cardiovascular diseases;
• Oncological neoplasms;
• Unfavorable course of pregnancy, difficult labor, abortion;
• Thrombosis;
• Osteochondrosis of the cervical spine (this disease prevents the normal flow of blood into the cranial cavity);
• A variety of infections affecting the central nervous system (encephalitis, meningitis, hemorrhagic fever, etc.).

The recurrence of the syndrome of the "empty Turkish saddle" significantly affects the size of the pituitary gland due to increased pressure inside the cranial cavity. It first increases markedly, forming a tumor, and then significantly reduced in volume due to necrosis, tissue disintegration, atrophy, and transferred neurosurgical and oncological operations.

Common cerebral symptoms

Basically, before going through a specialized survey, many people have no idea about the term "empty Turkish saddle". What kind of pathology and what is dangerous, many patients will know, only having on hand the results of tomography. Often they do not have any complaints, and they feel completely healthy. However, this does not mean that there can not be any complaints at all. Often neurological symptoms are manifested in the following:

• Frequent headaches, sometimes permanent (they do not have a specific localization and have a different intensity);
• dizziness;
• Unsteady walking (a man throws from side to side);
• Decreased memory and concentration of attention, the appearance of absent-mindedness;
• Unnatural fatigue, a decline in the level of efficiency and endurance;
• Psychoemotional disorders.

Ophthalmic disorders

It is often possible to identify the suspicion of the disease with ophthalmic doctors. Patients come to them with complaints about the deterioration of the state of the organs of vision. Such changes are often observed:

• Pain when moving the eyeball;
• Constant tear;
• Edema of the conjunctiva;
• Fogging;
• Bright flashes in the eyes.

During a detailed examination, specialists can detect some characteristic pathological manifestations, which include swelling and flushing of the optic nerve, distortion of the field of vision, and the appearance of asthenopia. Such dysfunctions of the human visual system may be present due to high intracranial pressure. In the absence of timely taking the necessary therapeutic measures, further hypersecretion of the intraocular fluid can lead to the formation of glaucoma.

Changes in the endocrine system

As mentioned earlier, the majority of patients are women after 35 years. The manifestations of the disease directly depend on the phase of exacerbation and remission achieved. From the side of the endocrine system, most often there are disorders caused by autonomic syndromes:

• Deep dyspnea even in drowsiness, difficulty breathing;
• Chills, fever;
• Pain and aches in the body;
• Persistent low-grade fever ;
• Frequent syncope;
• Tachycardia, heart pain;
• Stool disorder.

The hormonal failure of the pituitary gland in medical practice was repeatedly taken as a manifestation of a cancerous tumor of the gland. In addition, the combination of a microadenoma and an "empty Turkish saddle" is not uncommon. Because of the difficult intake of the required number of hormones through the pituitary foot and the control of the hypothalamus over the gland, some sexual disorders may occur, not only in women but also in male patients (decreased libido and potency, amenorrhea, hypothyroidism, etc.). In severe cases, there is a possibility of occurrence of discharge of CSF through the nasal passage.

Diagnostics

For the purpose of detecting the disease, it is worth turning to the most reliable method. Today, an unconditional leader in diagnosing neurological diseases of the brain can be considered an MRI. The results of the performed tomography provide the largest amount of information about the patient's condition. It is important to take into account the primary complete safety of this type of examination.

In the picture of MRI in a patient with the syndrome of "empty Turkish saddle", visualization is available:

• Presence of cerebrospinal fluid;
• A noticeable deformation of the pituitary gland (curved shape resembling a crescent or sickle), a centrally located funnel;
• The suprasellar tank asymmetrically protrudes in the cavity of the Turkish saddle;
• The funnel of the gland considerably elongated and became thinner.

Using the method of determining intracranial hypertension, other indirect indicators (an increase in the size of the ventricles and spaces containing the cerebrospinal fluid) can be determined in the picture.

Doctors also resort to additional diagnostic methods, including laboratory clinical studies (venous blood sampling for determining the balance of hormones produced by the pituitary gland in plasma) and ophthalmologic examination of the status of the fundus.

Features of treatment

Asking whether the "empty Turkish saddle" syndrome can be cured, it should be understood that only complex therapeutic measures will help to solve this problem. After all, without the help of neurologists, neurosurgeons, endocrinologists and oculists, this is indispensable.

The primary syndrome of the "empty Turkish saddle", as a rule, does not need special treatment. Not delivering tangible troubles to the patient, the disease in this form does not pose a threat to life. Although sometimes there is a need for medication and certain hormone therapy.

In the case of a secondary syndrome without hormonal treatment is indispensable. Since essential changes are susceptible to vital glands, the hypothalamus and the pituitary gland, often this more severe stage of the disease can be cured only by the operative method. For example, when squeezing the optic nerves and sagging the intersection in the diaphragmatic hole, only the operation with the neurosurgeon can help. Indication for surgery is the outflow from the nose of the cerebrospinal fluid. The thin bottom of the Turkish saddle allows seeping into the liquor.

Forecasts for recovery

The chances of recovery are quite high, especially if the severity of clinical manifestations is low and the primary syndrome of an empty Turkish saddle is identified. Treatment of the emergent hypopituitarism with the help of hormone replacement therapy ends in most cases with a favorable outcome. However, often the prediction of the course of the disease is dependent on the accompanying pathologies of the pituitary gland and the brain.