Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor

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