Education in the form of a recess is formed in the body of the sphenoid bone of the human skull, called the Turkish saddle. A condition in which the invagination cavity between the soft and arachnoid brain intrasellyarnuyu area and squeezed pituitary insufficiency caused by the aperture of the sphenoid bone, called the empty sella syndrome (PTS).
This defeat can be a primary, if caused by physiological processes, or secondary, when detected after irradiation chiasmosellar area or surgery. In secondary empty sella syndrome brain aperture of the recess can not be broken.
For the first time, the term PTSD was proposed pathologist W. Bush in 1951, when he studied the autopsy of the dead 788 people and found that the illness that led to death, have not always been associated with the pathology of the pituitary gland.
The pathologist revealed the almost complete absence of the diaphragm sella in 40 cases, instead present on the bottom of the formation of the pituitary spreading in appearance resembling a thin layer of tissue. Then Bush has proposed a classification of forms of the syndrome, depending on the type of structure and volume of the diaphragm located between the medulla and cerebellum intrasellyarnyh tanks, which only in 1995 modified the TF Savostianov.
Mostly syndrome emerging empty sella syndrome diagnosed in multiparous women over the age of 40 years (80%), almost 75% of patients are obese.
The causes of the disease may act climax, hyper- and hypothyroidism, pregnancy and amenorrhea-galactorrhea syndrome.
The symptoms of empty sella syndrome
In most cases are asymptomatic condition, 70% of patients have a severe headache, which is why there is a need for radiographic skull through which the detected empty sella syndrome brain.
A possible manifestation of the syndrome is a decrease in visual acuity, bitemporal hemianopsia and narrowing of peripheral fields. The medical literature is increasingly common description of edema of the optic nerve at the TCP.
In a growing number of patients emerging empty sella syndrome is found in combination with the hypersecretion of tropic hormones and pituitary adenoma.
Under the influence of the pulsation of cerebrospinal fluid in rare cases there is a gap bottom sella, the consequence of which is a rare complication - rhinorrhea, requiring immediate surgery. Against the background of the empty sella syndrome occurs connection between sphenoid sinus and suprasellar subarachnoid space, which greatly increases the risk of meningitis.
The symptoms of empty sella syndrome may make endocrine disorders, which are the manifestations of change tropic pituitary function.
According to previously conducted studies, which are used in the radioimmunoassay and Stimulation of the sample, it was identified a high percentage of patients with subclinical forms of violations of the secretion of hormones.
So in 8 of 13 patients responded to the secretion of growth hormone stimulation of insulin-induced hypoglycemia was reduced, and in 2 of 16 patients had inadequate change adrenocorticotropic hormone, which is a stimulator of the adrenal cortex.
Also, the symptoms of empty sella syndrome are increasing the peptide hormone prolactin, motivational, emotional and personality disorders, autonomic disorders, accompanied by chills, headache, without a clear localization, the sharp increase in blood pressure and temperature, cardialgia, fainting, pain in the limbs and abdomen, shortness of breath and occurrence patient fear.
It is possible the development liquorrhea, memory impairment, disorders stool, difficulty breathing, chest pain, fatigue and decreased performance.
Diagnosis of empty sella syndrome
Is critical for the diagnosis and follow-up treatment strategies empty sella plays ophthalmologic examination. In identifying threats to the complete loss of the patient urgently needed surgical intervention.
Equally important laboratory tests, which is determined by the level of the pituitary hormones in plasma. It is also necessary for the diagnosis of disease and the impact survey radiography X-ray of the area of sella MRI and CT scan of the head.
Prevention and treatment of empty sella syndrome
Measures aimed at preventing the disease include:
- Avoidance of traumatic situations of thrombosis, tumors of the pituitary gland and the brain;
- Treatment fully inflammatory, including intrauterine, diseases.
Upon detection of the patient's primary syndrome PTSD treatment is usually not indicated, the main task is to convince the patient's doctor that the disease is completely safe. In some cases, hormone replacement therapy is needed, while at the secondary empty sella syndrome, it is necessary in each case.
Surgery for primary syndrome PTS shown only in two cases, namely:
- Slack in the aperture sella optic crossroads, which is why there is a violation of fields and compression of the nerves;
- At the end of the cerebrospinal fluid from the nose through a worm-bottom sella;
In secondary syndrome empty sella neurosurgeon, depending on the evidence, can prescribe treatment of pituitary tumors.
Empty sella syndrome is a condition in which the pituitary gland is squeezed and there is intussusception cavity between the soft and arachnoid brain intrasellyarnuyu area. According to statistics, the disease develops in the background of obesity, menopause, pregnancy, hyper and hypothyroidism. Treatment of primary and secondary syndrome neurosurgeon assigned on an individual basis, depending on the evidence.