Relationships between Intracranial Pressure and Diurnal Prolactin Secretion in Primary Empty Sella

Abstract

The role of the intracranial pressure (ICP) in the development and/or maintenance of the primary empty sella has been evaluated by recording the ICP during sleeping and waking periods in 11 women who had this syndrome. Concomitantly, plasma PRL levels, measured at 2-hour intervals during a 24-hour period, were compared with the changes in ICP. Daily PRL variations were also measured in 5 normally cycling and 5 postmenopausal women. ICP was abnormally increased in 8 patients with PES. In 3 of them, increased values were recorded during waking and sleeping periods, while in 5 subjects abnormal values were observed only during sleep. In the remaining 3 patients the ICP was normal in all conditions tested. 8 patients with elevated ICP presented an absent or blunted nocturnal PRL increase. In 3 patients with normal ICP, the circadian periodicity of PRL was preserved. The normalization of ICP obtained in 4 patients by a surgical shunting procedure was accompanied by the return to normal of the circadian PRL periodicity. Our observations demonstrate that the finding of a normal ICP during wakefulness is not sufficient to rule out an actual increase in ICP, since a rise in the CRF pressure can occur during sleep. Our data also demonstrated a correlation between an abnormal rise in ICP and an absent or blunted nocturnal increment in PRL secretion.

Reliability of preoperative assessment of cerebrospinal fluid pressure in the management of spontaneous cerebrospinal fluid leaks and encephaloceles

“…7,9 Interestingly, the majority of patients with empty sellae do not have typical signs or symptoms of elevated ICP. [10][11][12] Clinical evidence of elevated pressure measurement and radiographic findings of empty sella and a thinned skull base have led to a theory of pulsatile hydrostatic forces seeking exit through natural paths of least resistance. Skull base sites naturally at the most risk are the cribriform plate and sites adjacent to extensively pneumatized sinuses such as the lateral sphenoid sinus, 2 common sites of spontaneous CSF leaks and meningoencephaloceles.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

“…Furthermore, it must be noted that menstrual irregularities (hypo, hyper, oligo, poly, amenorrhea, anovular cycles or short luteal phases) may also occur while there is a normal PRL level: this can be explained as hypersensibility to normal PRL values or transient hyperprolactinemia, which are not possible to observe with a single basal blood sample. In fact, an alteration of PRL circadian rhythm has been described in PES, associated with a chronic or intermittent altered intracranial pressure: the nightly PRL increment is reduced or completely lacked in patients with intracranial hypertension, even just during the REM phase (47,48). Rarely, pituitary hypersecretion condition was described in patients with PES associated to ectopic GH-and ACTHsecreting pituitary adenomas (49,50), located within the midline intersphenoidal septum.…”

Petrous apex cephalocoele: contribution of coexisting intracranial pathologies to the aetiopathogenesis

“…Maira et al 25 performed continuous ICP monitoring on 11 patients with idiopathic empty sella syndrome. 27% of the patients had elevated ICP while awake, 45% had elevated ICP while in rapid eye movement sleep and only 27% had normal ICP at all times.…”