What is visible in the picture and where does it come from?
The pituitary gland is separated from the cranial cavity by a thin septum with an opening for the pituitary stalk. If the septum is underdeveloped or weakened, and the pressure of the cerebrospinal fluid is increased, the membrane is gradually pressed into the sella. In this case, the pituitary gland is not destroyed, but is flattened and distributed along the bottom in a thin layer, continuing to work. There is a primary form, when the cause is an anatomical feature, and a secondary form, which occurs after surgery, irradiation, hemorrhage into the pituitary gland, or reduction of a previously enlarged gland.
- The primary form is congenital septal weakness
- Secondary - after surgery, radiation, hemorrhage
- Full and partial empty saddle
- The pituitary gland is preserved, but spread out along the bottom
- The discovery is often accidental
Who encounters more often
This finding is more common in middle-aged women, especially those who are overweight and have had multiple pregnancies: during pregnancy, the pituitary gland enlarges and then shrinks, and the sella may remain relatively loose. A separate group is people with increased intracranial pressure, in whom an empty sella is combined with headache and visual complaints. The secondary variant is expected after interventions on the pituitary gland. The primary form has no hereditary transmission.
- Middle aged women
- Overweight and Obesity
- History of several pregnancies
- Increased intracranial pressure
- Previous operations and irradiation of the pituitary gland area
- Previous history of pituitary hemorrhage
Symptoms: when complaints are really related
Most people have no symptoms, and the conclusion comes as a surprise. If there are complaints, most often it is a headache, which, however, can also happen for many other reasons. Hormonal manifestations occur only in some patients and are associated with a lack of certain pituitary hormones: weakness and low blood pressure with a lack of stimulation of the adrenal glands, chilliness and swelling with a lack of thyroid-stimulating hormone, cycle disorders and decreased libido with a deficiency of sex hormones. Separately, there is a moderate increase in prolactin.
- Most often - no symptoms
- Headache
- Weakness, fatigue, low blood pressure
- Menstrual irregularities, decreased libido
- Chilliness, dry skin, weight gain
- Rarely - visual disturbances and fluid leakage from the nose
What examination is needed
After the MRI conclusion, the main thing is to check whether the pituitary gland is working. The endocrinologist prescribes basic hormonal tests and, if necessary, clarifying tests, which are carried out according to special rules. If you are concerned about a headache with visual disturbances, an examination by an ophthalmologist is added with an assessment of the visual fields and fundus, and a neurologist decides to rule out increased intracranial pressure. It is usually not necessary to repeat MRI regularly for asymptomatic findings.
- TSH and free T4
- Morning cortisol, stimulation tests if necessary
- Prolactin
- LH, FSH, sex hormones
- Examination by an ophthalmologist with assessment of visual fields
- Repeat MRI only when indicated
Treatment and observation
The anatomical feature itself is not corrected: operations with an empty sella turcica are rarely performed and only for special indications, for example, in case of leakage of cerebrospinal fluid or persistent visual disturbances. If hormones are normal and there are no complaints, treatment is not required; periodic monitoring is sufficient. If a hormone deficiency is detected, replacement therapy is prescribed, which is selected by an endocrinologist. When combined with increased intracranial pressure, weight loss and treatment prescribed by a neurologist are of great importance.
- Observation for asymptomatic cases
- Replacement therapy for confirmed hormone deficiency
- Weight loss for obesity
- Treatment of headaches and intracranial hypertension by a neurologist
- Surgical intervention only for special indications
- Monitoring hormones according to the schedule prescribed by your doctor