- What is a Turkish saddle?
- Pituitary gland
- Empty Saddle Team
- Types and symptoms of empty saddle syndrome
- Diagnosis and treatment of empty saddle syndrome
Empty saddle syndrome is a series of hormonal symptoms resulting from disorders of the pituitary gland. This gland may be compressed by the diaphragm located above and undergo deformation on a bone fragment called the Turkish saddle. The disease is most often diagnosed in women who are overweight after several pregnancies. Is it a serious disease? How is empty saddle syndrome treated?
Empty saddle syndromeis most often diagnosed in overweight women after numerous pregnancies, although it can also occur as a result of mechanical injuries in men and women of different ages. These types of disorders may occur in as much as 5% of the population.
What is a Turkish saddle?
The sphenoid bone is one of the bones that make up the base of the skull. It mainly protects the delicate parts of the brain, but also constitutes a kind of scaffolding - for example, co-creating, for example, the eye sockets, the visual canal and the paths of the optic nerve crossing. It connects closely with other bones - incl. the occipital bone, temporal bones or bones that make up the facial skeleton. The sphenoid bone consists of a shaft and larger and smaller wings, which makes it slightly butterfly-shaped.
On the upper surface of the shaft of the sphenoid bone there is a characteristic structure - the so-called Turkish saddle (Latin sella turcica). This name refers to the shape of a saddle used for horse riding. In front of it there is a saddle tubercle and a groove of the optic junction, along the sides there are furrows of the carotid artery, while directly behind the saddle is the cerebellum.
In the hollow of the Turkish saddle - in the so-called the bottom of the pituitary gland - is the pituitary gland. This endocrine gland has a number of important functions in the body, and such a special location also has a protective function, surrounding the organ on 3 sides with durable bone tissue. On the upper side, the pituitary gland is covered with a connective tissue layer - the so-called Turkish saddle diaphragm.
Pituitary gland
The pituitary gland - although its size only resembles a small bean seed - is one of the key endocrine glands. Its functioning is closely related to another part of the brain - the hypothalamus. Both these organs form the so-called hypothalamicpituitary - a complex endocrine system, the primary role of which is to maintain the organism's homeostasis.
The pituitary gland responds to hormonal signals from the hypothalamus, and as a result, it produces and releases a number of hormones on its own. The hypothalamic-pituitary system is regulated by feedback (mainly negative), which means that the production of one hormone inhibits the synthesis and secretion of another - thanks to which the system remains in balance.
The pituitary gland is located in the central part of the skull, in the Turkish saddle. Surrounded by cerebrospinal fluid, it almost completely fills the saddle structure.
This gland is composed of three lobes of different sizes. The anterior lobe is significantly larger and consists of glandular tissue that produces and secrete hormones. The minor lobe is a nerve lobe that forms part of the hypothalamus with which it connects with a characteristic funnel, also known as the pituitary stalk (composed of nerve fibers and small blood vessels).
Most hormones are secreted by the anterior, glandular lobe of the pituitary gland. Among the most important, the following can be mentioned:
- growth hormone (GH) - necessary in the processes of body growth, protein synthesis and the breakdown of spare substances,
- prolactin (PRL) - stimulates and increases milk production (lactation), in lactating women it inhibits estrogen secretion, blocking menstruation and ovulation (especially in the postpartum period),
- thyroid stimulating hormone (TSH) - determines the proper secretion of thyroid hormones: T3 (triiodothyronine) and T4 (thyroxine) regulating metabolic changes.
- follicle stimulating hormone (FSH) - involved, among others, in the maintenance of the follicle dominant in the ovary and the regulation of the phases of the menstrual cycle in women
- luteinizing hormone (LH) - supports ovulation and progesterone production in women, in men it stimulates testosterone synthesis in the testicles;
The posterior part of the pituitary gland, although smaller and hidden in the structures of the anterior lobe, performs no less important functions. It stores 2 other important hormones:
- oxytocin - a key hormone for proper labor (increases contractions, stimulates lactation, helps to stop hemorrhage after the birth of a child);
- vasopressin (antidiuretic hormone, ADH) - stimulates the recovery of water in the renal tubules, which results in urine thickening; protects against dehydration of the body, regulates blood pressure.
In turn, the middle lobe secretes a peptide that stimulates the pigment cells found in the skin to produce melanin (melanotropin, MSH), as well as a hormone that enhances the digestion of fats and the release of free acidsblood fatty acids (lipotropin, LPH).
As you can see, the pituitary gland functions as a perfectly organized factory. Any disorders related to the excessive or insufficient secretion of its hormones lead to very serious systemic and metabolic disorders.
Hypopituitarism is associated with retarded growth in children, impaired maturation and fertility. On the other hand, its hyperactivity (often resulting from changes of neoplastic origin) may manifest itself in too early sexual maturation, gigantism or acromegaly.
Pituitary dysfunction can also be caused by taking exogenous hormones like testosterone or GH. Such therapies are most often used by strength sports players to drastically increase strength and muscle mass. Strong drugs (e.g. used in the treatment of schizophrenia, depression and painkillers) can also affect its work.
It is important to be aware that interference with the secretory system can lead to a blockage of the hypothalamic-pituitary axis. The return of the body to the state before the "hormonal treatment" can take years!
Empty Saddle Team
Anatomically, the pituitary gland tightly fills the space of the Turkish saddle, and its correct position is determined from above by the diaphragm (a type of connective tissue membrane).
It may happen, however, that one of the meninges (arachnoid) - located directly above the pituitary gland begins to lower and sink into the area of the Turkish saddle. Such chronic changes cause compression of the pituitary gland and its "flattening" - and thus functional disorders in the secretion of hormones. Ailments that are associated with the Turkish saddle are called empty saddle syndrome.
Types and symptoms of empty saddle syndrome
Clinically, two types of empty saddle syndrome can be distinguished: primary and secondary. The primary type of disease is usually the result of congenital developmental disorders (when the diaphragm is not developed or its defective structure prevents the pituitary gland from being properly held).
Often, however, this type of disease does not give any specific symptoms and can be diagnosed accidentally during other imaging examinations of the head.
Secondary empty saddle syndrome is associated with pituitary damage resulting from surgery or radiotherapy (irradiation) used, for example, in the oncological therapy of brain tumors. The chronic inflammatory process in the area of the optic nerve junction can also lead to deformation of the diaphragm tissue.
The most common complication of this type of change is hyperprolactinemia - that isincreased levels of the hormone prolactin (secreted from the anterior pituitary gland) in the blood serum. Symptoms that should be noted in women may include :
- menstrual disorders,
- milk leakage from the nipples (in non-pregnant or lactating women),
- hot flashes,
- vaginal dryness,
- bone decalcification (osteoporosis).
Hyperprolactinemia manifests itself differently in men, and its most important symptoms are:
- libido and erectile dysfunction
- infertility, enlargement of the mammary glands (gynecomastia),
- reduction of muscle mass
- scanty pubic hair
- bone decalcification (osteoporosis).
The secretion of other hormones, such as vasopressin, is also disturbed as a result of empty saddle syndrome. A symptom of its deficiency may be diabetes insipidus - a disease resulting from the inability to concentrate urine properly. Affected people, despite drinking huge amounts of water and thirsting, suffer from progressive dehydration and excessive sodium concentration in the blood (hypernatremia).
In rare cases of empty saddle syndrome, the optic nerves may be pinched, causing headaches or visual field defects.
Diagnosis and treatment of empty saddle syndrome
The diagnosis of empty saddle syndrome is not always easy due to the large number of non-specific symptoms of this disease. The most important for the detection of the disease are imaging tests: computed tomography (CT) and magnetic resonance imaging (MRI), which allow to locate the anatomical basis of the problem.
In primary empty saddle syndrome - if pituitary function remains normal - no treatment is required and the disease does not deteriorate quality of life.
If you find a secondary type of disease - it will be necessary to perform detailed blood tests to determine the concentration of hormones (including prolactin, TSH, growth hormone, vasopressin).
Hypopituitarism will interfere with the function of other endocrine glands, therefore supplementing the missing hormones will be a frequent therapeutic strategy. For example, levothyroxine (used in hypothyroidism or Hashimoto's disease) can be delivered in the form of tablets.
In the case of hyperprolactinaemia, pharmacotherapy is used to normalize the level of prolactin and restore the physiological function of the gonads. Surgical procedures for empty saddle syndrome are used very rarely, only in the case of circulatory disturbances in a given place.
Empty saddle band is nota life-threatening condition, however, it may have an effect on systemic endocrine disorders. Depending on the cause and severity of symptoms, its treatment may require specialized hormone therapy.