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The configuration and relations of the pituitary gland and fossa: a radiological, pathological and clinical study

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McLachlanMSF_1971_v2redux.pdf (6.151Mb)
Date
1971
Author
McLachlan, Maurice S. F.
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Abstract
 
 
In 50 adult necropsies, measurements of linear dimensions and volume of the normal pituitary gland were correlated with corresponding measurements of the sella turcica obtained from radiographs. Though the female pituitary gland was significantly larger than the male, there was no significant sex difference in sellar size. Dimensions of gland and fossa were correlated separately for each sex. Correlation between gland volume and estimated sellar volume was good. The length of the sella and the width of its floor correlated well with the length and-width of the gland, but correlation between measurements of sellar height and gland height was poor, especially in women.
 
Detailed studies of the radiological anatomy of these glands and fossae showed wide variation in the configuration of the diaphragma sellae, particularly in the position of its central portion relative to bony landmarks. In several a sub-diaphragmatic extension of the subarachnoid space was found. The shape of the gland varied markedly and was frequently distorted by compression by the carotid arteries. Bony configuration was also altered by these arteries which in some cases eroded the lateral margins of the dorsum sellae, undercutting the posterior clinoid processes. Some other variations in sellar contour are illustrated and discussed.
 
To evaluate radiological criteria of abnormality in the light of such wide normal variation, radiographs of the pituitary fossa of 140 acromegalic patients were assessed. Over half were grossly abnormal, showing marked bony erosion and enlargement. In a quarter, a double sellar contour was present, but, since dimensions of the inner contour were normal or only slightly enlarged, abnormality was often overlooked. The remainder (18%) presented particular diagnostic difficulty. On plain films, commonly accepted criteria of abnormality discriminated poorly between this group and controls. Measurement of sellar dimensions, because of the wide normal range, was also unhelpful. However, tomography of the sella demonstrated significant abnormality in almost all and frequently revealed downward extension of the pituitary tumour unsuspected on plain films. Combined assessment by plain films and tomography showed sellar abnormality in nearly 99% of the 140 patients.
 
To demonstrate suprasellar anatomy, tomography in two planes was combined with pneumoencephalography in 37 patients suffering from various types of pituitary tumour. Examinations were successful in all but one, showing a wide variation in the position of the superior aspect of the tumour. Suprasellar extensions were not predictable on the basis of bony configuration of the sella and frequently failed to produce visual field defects. Subarachnoid extensions into the sella were also demonstrated. Attention is drawn to the implications of these variations and the importance of their demonstration before therapeutic procedures on the pituitary gland are undertaken.
 
URI
http://hdl.handle.net/1842/35265
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