Empty Turkish saddle

The education in the form of deepening forming in a body of a wedge-shaped bone of a skull of the person is called the Turkish saddle. The state at which there is cavity invagination between soft and web covers of a brain to the intrasellyarny area and is squeezed a hypophysis, caused by insufficiency of a diaphragm of a wedge-shaped bone, call the empty Turkish saddle (ETS).

This defeat can be primary if it is caused by physiological processes, or secondary when it is found after radiation of hiazmalno-sellyarny area or an operative measure. At a secondary empty Turkish saddle of a brain the diaphragm of the deepening can be not broken.

For the first time the term PTS was offered by the pathologist V. Bush in 1951 when he studied autopsiyny material of the died 788 people and found out that diseases which led to a lethal outcome were not always connected with hypophysis pathology.

The pathologist revealed almost total absence of a diaphragm of the Turkish saddle in 40 cases, instead there was on day of education a hypophysis rasplyvaniye by the form reminding a thin layer of fabric. Then Bush offered classification of the forms of a syndrome, depending on type of a structure of a diaphragm and volume located between a medulla and a cerebellum of intrasellyarny tanks which only in 1995 was modified by T. F. Savostyanov.

Preferential the syndrome of the forming empty Turkish saddle comes to light at the multigiving birth women aged 40 years are more senior (in 80% of cases), nearly 75% of patients have obesity.

Can act as causes of illness a climax, hyper - and a hypothyroidism, pregnancy and a syndrome of a galactorrhoea amenorrhea.

Symptoms of an empty Turkish saddle

In most cases the state proceeds asymptomatically, 70% of patients have a severe headache because of what there is a need for a skull X-ray analysis by means of which the empty Turkish saddle of a brain is found.

Possible manifestation of a syndrome is decrease in visual acuity, a bitemporal hemianopsia and narrowing of peripheral fields. In medical literature the description of hypostasis of an optic nerve even more often meets at PTS.

The forming empty Turkish saddle is found in the increasing number of patients in combination with hypersecretion of tropny hormones and adenoma of a hypophysis.

Under the influence of a pulsation of cerebrospinal fluid in rare instances there is a rupture of a bottom of the Turkish saddle which consequence the rare complication – a rhinorrhea is, demanding immediate surgical intervention. Against the background of a syndrome of an empty Turkish saddle there is a communication between a sphenoidal sine and a suprasellyarny subarachnoid space that considerably increases risk of development of meningitis.

Endocrine disturbances which manifestations are changes of tropny functions of a hypophysis can act as symptoms of an empty Turkish saddle.

According to the researches conducted earlier at which radio immune methods and stimulation tests were used the high percent of patients with subclinical forms of disturbance of secretion of hormones was revealed.

So at 8 of 13 patients the response of secretion of a growth hormone to stimulation was lowered by an insulin hypoglycemia, and at 2 of 16 patients inadequate changes of the adrenocorticotropic hormone which is a stimulator of bark of adrenal glands were revealed.

Also symptoms of an empty Turkish saddle are the increase in peptide hormone of prolactin, motivational and emotional and personal frustration, vegetative disturbances accompanied with a fever, a headache without accurate localization, sharp increase in the ABP and temperature, a cardialgia, faints, extremity and stomach pains, an asthma and emergence at sick sensation of fear.

Development of a liquorrhea, memory impairment, frustration of a chair, breath difficulty, pain in heart, bystry fatigue and decrease in working capacity is not excluded.

Diagnosis of an empty Turkish saddle

Exclusive importance for diagnosis and the subsequent tactics of treatment of an empty Turkish saddle is played by ophthalmologic inspection. At identification of threat of total loss of sight the patient needs urgent surgical intervention.

Laboratory researches by means of which the level of hormones of a hypophysis in a blood plasma is defined are not less important. Also the survey roentgenogram and an aim x-ray film of area of the Turkish saddle, head MPT and KT is necessary for diagnosis of a disease.

Prevention and treatment of an empty Turkish saddle

The measures directed to prevention of a disease include:

• Avoidance of injury-causing situations, developing of thromboses, tumors of a hypophysis and brain;
• Treatment in full inflammatory, including pre-natal, diseases.

At detection at the patient of primary syndrome of PTS treatment is usually not appointed, the main task of the doctor is to convince the patient that the disease is absolutely safe. Replacement hormonal therapy whereas at a secondary empty Turkish saddle it is necessary in each case is in certain cases necessary.

Surgical intervention at primary syndrome of PTS is shown only in two cases, namely:

• When sagging in an opening of a diaphragm of the Turkish saddle of the visual intersection because of what there is a disturbance of fields and a prelum of nerves of sight;
• At the expiration from a nose of cerebrospinal fluid through the pierced bottom of the Turkish saddle;

At a secondary syndrome of an empty Turkish saddle the neurosurgeon, depending on indications, can appoint treatment of a tumor of a hypophysis.

Empty Turkish saddle call a state at which the hypophysis is squeezed and there is cavity invagination between soft and web covers of a brain to the intrasellyarny area. According to statistical data, the disease develops against the background of obesity, a climax, pregnancy, hyper - and a hypothyroidism. Treatment of primary and secondary syndrome is appointed by the neurosurgeon in an individual order, depending on indications.