Empty sella syndrome (ESS) is a specific anatomical and functional syndrome resulting from partial or complete emptying of the sella turcica. This is a structure located in the sphenoid bone of the skull that houses the pituitary gland, a vital gland that regulates many hormonal processes in the body. ESS can manifest as a clinically significant condition, with symptoms related to dysfunction of the pituitary gland, including hyperproduction or hypoproduction of hormones. Symptoms of the syndrome can vary from minor changes to severe endocrine disorders, as well as other neurological manifestations.
History of the disease and interesting historical facts
Empty sella syndrome was first described in 1951 by American neurosurgeon L. M. E. Trotter. It was initially associated with depletion of the pituitary gland due to intracranial processes such as tumors and brain injuries. Interestingly, clinical observations of this condition have increased with the introduction of modern imaging techniques such as MRI, which have made it possible to more accurately diagnose PTSS and detect its presence in patients without pronounced symptoms. Later studies have shown that the syndrome is more often diagnosed in women, which opens up new horizons for understanding its etiology and pathogenesis.
Epidemiology
Statistics on empty sella syndrome show a significant prevalence of this condition in the population. PTSS occurs in 5-27% cases on MRI studies of the brain, but many patients remain asymptomatic, making it difficult to accurately determine the true prevalence. The syndrome is more common in women, especially between the ages of 30 and 50. This may be due to hormonal changes characteristic of this age period. The specificity of prevalence may vary depending on ethnicity and other sociocultural factors.
Genetic predisposition to this disease
To date, the genetic predisposition to empty sella syndrome has not been adequately studied. However, there is a possibility that individual genes and mutations may be involved in the development of this disease. In particular, the influence of genes responsible for adequate development and function of the pituitary gland, as well as genes involved in the regulation of hormonal balance, such as genes responsible for the synthesis of adrenocorticotropic hormone (ACTH), are being studied. The possibility of a multifactorial etiology associated with the interaction of genetic and environmental factors is also assumed.
Risk factors for the development of this disease
There are several factors that may contribute to the development of empty sella syndrome, including:
- Genetic predisposition: presence of pituitary gland diseases in relatives.
- Head injuries: Acute and chronic traumatic brain injuries may increase the risk of developing PTSD.
- Hormonal changes: pregnancy, menopause and other conditions associated with changes in hormonal levels.
- Use of certain medications: Some drugs used to treat diseases related to the pituitary gland.
- Chronic diseases: such as diabetes and hypertension.
Diagnosis of this disease
Diagnosis of empty sella syndrome includes several key aspects:
- The main symptoms are headaches, visual disturbances, changes in appetite and weight, and dysfunctions in the endocrine system.
- Laboratory tests: determination of the level of hormones produced by the pituitary gland, such as TSH, ACTH, prolactin and others.
- Radiological examinations: MRI and CT to visualize the structure of the sella turcica and identify its changes.
- Other types of diagnostics: ophthalmological examinations to assess the state of the visual fields and possible visual impairments.
- Differential diagnosis: it is necessary to exclude pituitary tumors, neuroinfections and other diseases that can cause similar symptoms.
Treatment
Treatment for empty sella syndrome depends on its clinical manifestations and may include:
- General treatment: lifestyle changes, maintaining a normal level of physical activity and diet.
- Pharmacological treatment: hormone replacement therapy to correct the deficiency of excitatory or suppressive hormones.
- Surgical treatment: may be necessary in cases of severe tumors or other light-filtering conditions.
- Other types of treatment: physiotherapy and psychotherapy to improve general condition and emotional background.
List of medications used to treat this disease
Drug treatment for empty sella syndrome may include:
- Levothyroxine (to correct thyroid status).
- Glucocorticoids (in case of ACTH deficiency).
- Estrogens and progestogens (to correct the menstrual cycle).
- Selective serotonin reuptake inhibitors (in case of depressive symptoms).
Disease monitoring
Monitoring of a patient with empty sella syndrome should include:
- Control stages: regular examinations of hormone levels and visual examinations.
- Prognosis: A large number of patients can live with PTSD without symptom progression, but ongoing monitoring is necessary.
- Complications: May include a variety of endocrine disorders and visual problems.
Age-related features of the disease
Empty sella syndrome can present differently depending on age:
- Children: PTSD in childhood may be associated with growth and developmental delays.
- Adolescents: May affect menstrual cycle, energy levels and psycho-emotional status.
- Adults: endocrine disorders associated with increased or decreased hormone levels occur more often.
- Older adults: Symptoms may be more severe, with a higher risk of complications.
Questions and Answers
- What is empty sella syndrome? This is a condition associated with anatomical changes in the sella turcica, which can lead to dysfunction of the pituitary gland.
- What are the main symptoms of this syndrome? The main symptoms include headaches, visual disturbances, changes in appetite and metabolic problems.
- How is empty sella syndrome diagnosed? Diagnosis includes assessment of clinical symptoms, laboratory tests of hormone levels, and radiological methods such as MRI.
- Is there a treatment for this disease? Yes, treatment depends on the severity of symptoms and may include both drug therapy and surgery.
- Who is at risk for this disease? The syndrome is most often observed in women aged 30 to 50 years, as well as in patients with head injuries and endocrine disorders.
Advice from Dr. Oleg Korzhikov
Dr. Oleg Korzhikov recommends paying attention to the following questions and aspects that concern his patients:
— “What diagnostics are the most informative?” — MRI is the most sensitive method for detecting changes in the sella turcica area.
— “How to maintain your health if you have PTSD?” — It is important to undergo regular check-ups and follow your doctor’s recommendations regarding lifestyle.
— “Is it possible to prevent the development of complications?” — Timely diagnosis and treatment of endocrine disorders can significantly reduce the risk of complications.
— “How to avoid stress in everyday life?” — Practice meditation and physical activity to reduce stress levels, which will help in dealing with the symptoms of the disease.
— “When should I see a doctor?” — If any symptoms associated with headaches or changes in the endocrine system appear, it is recommended to immediately consult a doctor for diagnosis and treatment.
