Dear All,
Is brain empty sella considered a mental disorder?
What is the gold standard to treat this "disorder"?
Thank you for your kind input.
Best regards - Mariam
Dear Mariam,
These resources may interest you.
https://www.nlm.nih.gov/medlineplus/ency/article/000349.htm
http://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/empty-sella-syndrome
https://books.google.com/books?id=oPJOBQAAQBAJ&pg=PA761&dq=treatment+for+empty+sella+syndrome&hl=en&sa=X&ved=0ahUKEwjZ1uK9i-zNAhUN1WMKHXaaAOQQ6AEIQDAG#v=onepage&q=treatment%20for%20empty%20sella%20syndrome&f=false
Dear Prof Stephen,
Thank you for the great references.
I gather, it is like curtailing the symptoms more than treating the "disorder". I could safely assume that there is still no gold standard to treat such illnesses.
Best regards - Mariam
Dear Mariam,
The links provide only the basic information on empty sella syndrome. It is wise to consult one's physician about the same.
Warm regards,
Stephen
I think an empty sella is a secondary consequence of excessive CSF drainage into the nasal sinuses. So some mental symptoms may occur as a result of CSF hypotension, as with CSF fistulas or after some lumbar punctures.
Empty sella is a descriptive radiological term without relation to a disorder. Mostly, it an incidental finding as variant of normal anatomy. The associations with various disease have to be discussed with regard to the fact why brain imaging has been done. E.g. in typical tension-type headache, it would be an incidental finding as well as in acute frontal stroke, whereas it partly indicates the problem in intracranial hypertension. A mental disorder might exist following endocrine disturbances or the underlying disease, but not following the empty sella itself.
Empty Sella is a pathological condition, an abnormal anatomical finding. Your question had no description of a mental state associated with it. There may be several different ones not all of which are abnormal. Psychiatry is the care and study of normal and abnormal mental states (cognitive, emotional, experiential and behavioral) and mental dispositions (cognitive and affective traits). Sorry to be so didactic but we have to describe what we are observing accurately if we are to understand it from its origins to its impacts.
Only Professional should be engaged in the diagnosis and treatment of any disease, including all of the brain diseases.
Dear Anthony,
I share your kind feedback. Thank you.
Best regards - Mariam
Dear Mr Singh,
Thank you for your comprehensive references. They are enlightening indeed. There are mentions that empty sella is a rare "disorder" / "disease" in some literature.
Best regards - Mariam
Dear Dirk,
Thank you for your kind information.
It is true empty sella is usually an incidental radiological findings. The relations to hypertension and tensions headache are real indeed. It is comforting to note that empty sella would not lead to any mental disorder, per se.
Best regards - Mariam
Dear J Raymond,
True enough. But the empty sella that I observed was the incidental radiological finding from a chronic headache patient with hypertension background.
There is no request for psychiatry intervention as yet as it is more of a neuro referral.
Thank you for your kind input.
Best regards - Mariam
Dear Vladimir,
Yes - in all cases, the professionals need to be consulted.
For this instance, it is just an incidental radiological indication. The empty sella diagnosis is never done at this stage.
Thank you and best regards - Mariam
Empty sella syndrome (ESS) that mainly affects young, obese women, is not a mental problem since it’s origin of occurrence is pituitary gland shrinkage/ flattening due to leakage of CSF into sella turcica, leading to intracranial pressure and headache. Early onset of puberty, growth hormone deficiency/ and or dysfunction of pituitary gland, intracranial hypertension either with unknown or secondary causes, and epidermoid cysyt are the diagnostic features.
Except surgery in some cases, treatment associated with pituitary malfunction is symptomatic and hence supportive.
Dear Zahir,
Thank you for your informative feedback.
Unfortunately, the affected person is mildly obese, 54 yo, htn, left-sided migraine with headache, complex regional pain syndrome (crps) at systemic stage (stage 3) with recurrent syncope.
The MRI was conducted owing to the latter and the finding of the ESS was incidental and no neurologist was referred to ascertain any malfunction in pituitary nor epidermoid cyst was deliberated.
The patient has nfu till date - pathetically. And the symptomatic ESS coupled with other debilitating conditions remain non treated.
Best regards.
Mariam
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