Plain film and tomographic assessment of the pituitary fossa in 140 acromegalic patients

Abstract

Radiographs of the pituitary fossae of 140 acromegalic patients have been studied. Patients were divided into three groups on the basis of plain film appearances. Group A (55 per cent) showed gross abnormality. In Group B (27 per cent) a double contour was present, the dimensions of the inner contour being normal or only slightly enlarged. Our findings suggest that abnormality is easily missed in this group. Group C (18 per cent) provided particular diagnostic difficulty and was studied in greater detail Commonly accepted criteria of abnormality on plain films and measurement of fossa dimensions discriminated poorly between control and Group C fossae. Tomography showed signicant abnormalities in the majority of Group C fossae, and major downward extensions unsuspected on plain films in more than a third. Combined assessment by plain film and tomography showed abnormalities in 138 of the 140 patients. Tomography of the sella is indicated in patients with clinical or biochemical evidence of abnormality of pituitary function even when plain films appear normal.