Syndrome of "empty" Turkish saddle: causes, symptoms, diagnosis, treatment

Quite often, the syndrome of the "empty" Turkish saddle is asymptomatic. In the presence of symptoms, the clinical picture is extremely diverse. The main manifestation of the syndrome of the "empty" Turkish saddle (PTS) - violations of hypothalamic-pituitary functions of varying degrees. Possible headaches in the forehead, the flow of cerebrospinal fluid from the nose when coughing and sneezing, changing the fields of vision. Neuro-exchange-endocrine syndromes are represented very widely: cerebral obesity with oligo- or amenorrhea, persistent galactorrhea-amenorrhea syndrome, myxedema, false pseudohypoparathyroidism, acromegaly, diabetes insipidus, panhypopituitarism, partial hypopituitarism, subclinical abnormalities in the level of secretion of tropic hormones. Clinical symptoms are extremely dynamic, the interchangeability of one neuroendocrine syndrome with another, spontaneous remissions. Emotional-personal, motivational and vegetative disorders are quite significant, however, there is no specific specificity.

On the roentgenogram of the skull in 80% of cases find an increase in the size of the Turkish saddle, thinning of its back, the shape of the Turkish saddle is usually cylindrical. Often there is a hydrocephalic shape of the skull, a phenomenon of a hypertensive nature. However, the syndrome of the empty Turkish saddle can proceed against the background of a normal radiographic picture.

In the clinical picture, the symptoms of benign intracranial hypertension - "pseudotumor brain", which are characterized by hypertensive headaches, edema of optic discs, an increase in intracranial pressure with the normal composition of the cerebrospinal fluid, may play a primary role in the clinical picture. Diagnosis is possible after pneumoencephalography or sight CT. It is more often observed in pregnant women, after prolonged use of oral contraceptives, against the background of hypertension, after hormone replacement therapy.

The causes of the syndrome of the "empty" Turkish saddle. There are primary and secondary syndrome of an empty Turkish saddle. Among the etiological factors of the primary syndrome, the congenital inferiority of the diaphragm of the Turkish saddle, transient hyperfunction and pituitary hyperplasia with subsequent involution (pregnancy, prolonged use of oral contraceptives, hormone replacement therapy), primary pressure of cerebrospinal fluid (Pickwick syndrome, pseudotumor brain, arterial hypertension) . Congenital underdevelopment of the diaphragm can be aggravated by transient hyperfunction of the pituitary gland and its stem, and fluctuations in pressure of the cerebrospinal fluid lead to the introduction of a spider web with fluid into the cavity of the saddle.

The causes of the secondary syndrome of the empty Turkish saddle are a violation of the diaphragm of the Turkish saddle during neurosurgical intervention and the formation of free space in the cavity of the Turkish saddle as a result of the removal of voluminous formation.

Pathogenesis of the syndrome of the "empty" Turkish saddle. When the congenital defective diaphragm of the Turkish saddle and with increasing intracranial pressure occurs as a result of various reasons, the swelling of the arachnoid shell filled with cerebrospinal fluid into the region of the Turkish saddle. The introduced "liquor bag" pushes the pituitary gland toward the wall of the Turkish saddle, disrupting the functions of the mainly adenohypophysis. In addition, there is also compression of the pituitary stalk with a violation of hypothalamic control over pituitary functions. The latter reason is considered the most significant for the formation of neuroendocrine syndromes. The picture of neuroendocrine disorders depends on the quality of the constitutional inferiority of the cerebral systems of neuroendocrine regulation.

Differential diagnosis. First of all, it is necessary to exclude the volumetric process in the field of the Turkish saddle (tumor, cyst), hemorrhage into the tumor.

Treatment of the syndrome of the "empty" Turkish saddle. Surgical effects with the plastic of the diaphragm of the Turkish saddle are used only with the growth of visual disorders. Pharmacotherapy is the use of funds designed to reduce the pressure of cerebrospinal fluid, improve hemodynamics of the brain, normalize blood pressure. To this end, use vascular, dehydrating, antihypertensive drugs. Other therapeutic measures depend on the quality of neuroendocrine disorders.