An empty Turkish saddle is often asymptomatic and is accidentally detected during X-ray examination. The “empty Turkish saddle” is found mainly in women (80%), more often after 40 years of age, multipathing. About 75% of patients are obese. Clinical signs varied. Headache occurs in 70% of patients, which is the reason for the initial radiography of the skull, which in 39% of cases shows a modified Turkish saddle and leads to further more detailed examination. Headache varies widely in localization and extent - from mild, intermittent, to unbearable, almost constant.
Possible reduction of visual acuity, generalized narrowing of its peripheral fields, bitemporal hemianopsia. Swelling of the nipple of the optic nerve is rarely observed, but its descriptions in the literature are found.
Rhinorrhea is a rare complication associated with rupture of the bottom of the Turkish saddle under the influence of pulsation of cerebrospinal fluid. The emerging connection between the suprasellular subarachnoid space and the sphenoid sinus increases the risk of meningitis. The appearance of rhinorrhea requires surgical intervention, for example, the Turkish saddle tamponade with a muscle.
Endocrine disorders with an empty Turkish saddle are manifested in a change in the tropic functions of the pituitary gland. Studies using sensitive radio-immune methods and stimulation samples revealed a high percentage of hormone secretion dysfunction (subclinical forms). So, K. Brismer et al. Found that in 8 of 13 patients the somatotropic hormone secretion response to insulin hypoglycemia was reduced, and in the study of the pituitary-adrenal cortex axis, the secretion of cortisol after intravenous administration in 2 of 16 ACTH patients changed inadequately; reaction to metyrapone was normal in all patients. Unlike these data, Faglia et al. (1973) observed inadequate release of corticotropin on various stimuli (hypoglycemia, lysine-vasopressin) in all examined patients. The reserves of TSH and GT were also studied using TRG and RG, respectively. Samples showed a number of changes. The nature of these violations is still unclear.
There are more and more works describing the hypersecretion of tropic hormones in combination with an empty Turkish saddle. The first of these was information about a patient with acromegaly and an elevated level of somatotropic hormone. JN Dominique et al. Reported an empty turkish saddle in 10% of patients with acromegaly. Usually these patients also have pituitary adenoma. The primary empty Turkish saddle develops as a result of necrosis and involution by adenomas, and adenomatous residues continue to hypersecret the somatotropic hormone.
Most often, an increase in prolactin is observed in the “empty Turkish saddle” syndrome. Reported his growth in 12-17% of patients. As with GH hypersecretion, hyperprolactinemia and empty Turkish saddle are often associated with the presence of adenomas. Analysis of the observations shows that 73% of patients with an empty Turkish saddle and hyperprolactinemia have had adenomas during the operation.
There is a description of the primary “empty Turkish saddle” in patients with ACTH hypersecretion. These are more often cases of disease, Itsenko-Cushing disease with pituitary microadenoma. However, it is known about a patient with Addison's disease, in whom prolonged stimulation of corticotrophs due to adrenal insufficiency led to ACTH-secreting adenoma and an empty Turkish saddle. Of interest is the description of 2 patients with an empty Turkish saddle and ACTH hypersecretion at normal cortisol levels. The authors put forward an assumption about the production of ACTH-peptide with low biological activity and the subsequent infarction of hyperplastic corticotrophs with the formation of an empty Turkish saddle. A number of authors cite examples of isolated ACTH deficiency and an empty Turkish saddle, a combination of an empty Turkish saddle and adrenal carcinoma.
Thus, endocrine dysfunction in the empty Turkish saddle syndrome is extremely diverse. There are both hyper- and hyposecretion of tropic hormones. Violations range from subclinical forms detected by stimulation samples to pronounced panhypopituitarism. The variability of changes in endocrine function corresponds to the breadth of aetiological factors and the pathogenesis of the formation of a primary empty Turkish saddle.