Sphenoid sinus mucosal thickening in the acute phase of pituitary apoplexy

Mueez Waqar,Robert McCreary,Kanna K. Gnanalingham,Tara Kearney,Konstantina Karabatsou

doi:10.1007/s11102-017-0804-z

Abstract

PurposeIn pituitary apoplexy (PA), there are preliminary reports on the appearance of sphenoid sinus mucosal thickening (SSMT). SSMT is otherwise uncommon with an incidence of up to 7% in asymptomatic individuals. The aim of this study was to evaluate the incidence and clinical significance of SSMT in patients with PA and a control group of surgically treated non-functioning pituitary adenomas (NFPAs).MethodsRetrospective review of clinical and imaging variables in PA and NFPA patients. Sphenoid sinus mucosal thickness was measured on the presenting MRI scan by a blinded neuroradiologist. Pathological SSMT was defined as >1 mm adjacent to the pituitary fossa. Forward stepwise logistic regression was used to identify factors associated with SSMT.ResultsThere were 50 NFPA and 47 PA patients. PA patients were managed conservatively (N = 11) or surgically (N = 36). The median sphenoid sinus mucosal thickness was greater in the PA than NFPA groups (2.0 vs. 0.5 mm; p < 0.001). In multivariate analysis of both the PA and NFPA groups, the presence of PA was the only factor associated with SSMT (OR 0.043, 95% CI 0.012–0.16; p < 0.001). In multivariate analysis of the PA group alone, a shorter time from symptom onset to presenting MRI scan (OR 0.12, 95% CI 0.026–0.54; p = 0.006) and a more severe grade of apoplexy (OR 7.29, 95% CI 1.10–48.40; p = 0.04), were associated with SSMT.ConclusionThe incidence of SSMT is higher in patients with PA, especially during the acute phase of PA. The aetiology of SSMT in PA is unclear and may reflect inflammatory and/or infective changes.

Highlights

Classical pituitary apoplexy (PA) is a clinical syndrome of acute onset severe headache associated with nausea, meningism, visual impairment and decreased level of consciousness [1, 2]
A shorter time interval between symptom onset and the initial MRI scan emerged as the only reliable predictor of sinus mucosal thickening (SSMT) (i.e. 83 vs. 39% of patients when duration was longer than 1 week)
There was a lack of serial imaging analysis to explore the temporal nature of the sphenoid sinus mucosal changes in greater detail. These were beyond the scope of the present study. In this retrospective single-centre study, we observed an association between SSMT and PA, especially in the acute phase of PA

Summary

Introduction

Classical pituitary apoplexy (PA) is a clinical syndrome of acute onset severe headache associated with nausea, meningism, visual impairment (reduced visual acuity and ophthalmoplegia) and decreased level of consciousness [1, 2]. PA is secondary to haemorrhage and/or infarction into a pituitary adenoma, with a reported incidence of about 2–7% among patients with pituitary adenomas [1, 2]. Pituitary (2017) 20:441–449 in carefully selected patients, medical management may be appropriate [3]. The sphenoid sinus is the gateway to the pituitary fossa during trans-sphenoidal surgery. The sphenoid sinus is the least likely of the paranasal sinuses to be affected in healthy individuals [5, 6]. The reported prevalence of incidental sphenoid sinus mucosal thickening (SSMT) varies between 2–7% [5, 6]. In a Norwegian study of MRI scans of 982 individuals aged 50–65 recruited into epidemiological trials, SSMT was observed in only 136 cases with 1963 sinuses (one aplastic sphenoid sinus), representing a rate of 7% [6]

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