Objectives/Hypotheses: Pituitary adenomas, when characterized as “functioning,” may produce endocrinopathies
such as acromegaly and Cushing syndrome. Both conditions lead to characteristic anatomic
variations as a result of hormonally induced abnormal soft tissue deposition. Previous
studies have explored anatomic differences in acromegalics, including the association
with medialized carotid canals at the sella. In this study, we evaluate the anatomic
differences between acromegalics and Cushing disease patients, and compare these dimensions
to patients without pituitary adenomas or sinus disease.
Study Design: Radiographic review of preoperative magnetic resonance (MR) or computed tomography
(CT) images. Dimensions assessed were intercarotid distance; carotid canal width;
piriform aperture width; distance from piriform aperture to planum sphenoidale; sphenoid
sinus height, width, and length; angle from anterior nasal floor to planum sphenoidale;
choanal height; and nasal cavity height at level of the vertical segment of the middle
turbinate. Sphenoid sinus pneumatization patterns were recorded.
Methods: All patients who underwent transnasal, transsphenoidal surgery at a tertiary academic
medical center for pituitary adenomas found to have acromegaly or pituitary Cushing
between January 1, 2007 and September 1, 2015 were included in the study. In addition,
15 patients with CT scans of the sinuses without pituitary or sinonasal disease were
selected as controls.
Results: A total of 30 acromegalics and 31 Cushing disease patients were included in the study.
When compared to controls, both acromegalics and Cushing disease patients had significantly
wider piriform apertures and a longer distance from the piriform aperture to the planum
(p < 0.05). Acromegalics had a significantly less acute angle (19 ± 3°) from the floor
of the anterior nose to the sphenoid (p < 0.05). Cushing disease patients had significantly
greater sphenoid sinus length and shorter nasal cavity height (p < 0.05). There were
no differences in intercarotid distance or carotid canal width.
Conclusion: As acromegalics and Cushing disease patients have known anatomic variations, the
skull base surgeon should be aware of these differences and adapt their techniques
and approaches as needed. The angle from the anterior floor of the nose to the planum
sphenoidale may be less acute in acromegalics.
