Morphometric Analysis of the Sella Turcica and Sphenoid Sinus: A Retrospective Cross-Sectional Study / Análisis Morfométrico de la Silla Turca y Seno Esfenoidal: Un Estudio Transversal Retrospectivo

SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.

Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.

Sella turcica 3t magnetic resonance imaging in the diagnosis of cushing's disease in children: two case reports / Ressonância magnética 3t de sela túrcica no diagnóstico de doença de cushing em crianças: relato de dois casos

ABSTRACT Objective: To present two clinical cases of pediatric Cushing disease caused by adrenocorticotropic hormone secreting pituitary adenomas, which were diagnosed by magnetic resonance imaging using 3 Tesla technology. Case description: Two cases of Cushing disease in 9-year-old children are reported. Both children presented pituitary adenomas that were smaller than 5 mm at their largest diameter, and which were not seen by standard 1.5 Tesla resonance. One of the patients was submitted to bilateral and simultaneous catheterization of the inferior petrosal sinus, but the result was undetermined. In both cases, the pituitary adenoma was detected by 3 Tesla magnetic resonance imaging. Both patients underwent transsphenoidal surgery and were cured. Comments: Cushing disease presents high morbidity. Therefore, early diagnosis and prompt treatment are essential. It is usually caused by adenomas that are smaller than 5 mm in diameter. Surgery is the first line of treatment, and effective methods of locating the adenoma are necessary for greater therapeutic success. This report suggests that the 3 Tesla magnetic resonance imaging is more sensitive, and thus able to detect pituitary microadenomas (largest diameter <10 mm). This exam may be indicated as a low-morbidity diagnostic tool for finding pituitary microadenomas in Cushing disease that are not visualized by 1.5 Tesla magnetic resonance imaging.

RESUMO Objetivo: Apresentar dois casos clínicos de Doença de Cushing infantil decorrentes de adenoma hipofisário secretor de hormônio adrenocorticotrófico, cujo diagnóstico foi realizado por meio da ressonância magnética pela tecnologia 3 Tesla. Descrição do caso: São relatados dois casos de Doença de Cushing em crianças aos nove anos. Ambas apresentavam adenomas menores que 5 mm em seu maior diâmetro que não foram visualizados por meio de ressonância magnética de sela turca utilizando tecnologia 1,5 Tesla. Uma das pacientes foi submetida ao cateterismo bilateral e simultâneo do seio petroso inferior, porém com resultado indeterminado. Nas duas, o adenoma hipofisário foi visualizado mediante ressonância magnética utilizando tecnologia 3 Tesla. Ambas foram submetidas à cirurgia transesfenoidal e evoluíram para cura. Comentários: A Doença de Cushing apresenta alta morbidade, necessitando de diagnóstico e tratamento precoces, e geralmente é causada por adenomas com diâmetro inferior a 5 mm. O tratamento é cirúrgico, sendo preciso utilizar métodos eficazes de localização do adenoma para maior sucesso terapêutico. Esses relatos sugerem que a ressonância magnética 3 Tesla tem mais sensibilidade na detecção de microadenomas hipofisários (maior diâmetro <10 mm), podendo-se indicar esse exame como uma ferramenta diagnóstica de baixa morbidade na localização de microadenomas hipofisários na Doença de Cushing não visualizados pela ressonância magnética 1,5 Tesla.

Variaciones anatómicas de la silla turca en radiografías laterales de cráneo. Hospital "Faustino Pérez", 2017-2018 / Anatomic variants of sella turcica in lateral crania radiographies. Hospital "Faustino Pérez¨, 2017-2018

RESUMEN Introducción: diversos autores reflejan que la morfología de la silla turca constituye un factor predisponente para algunas enfermedades. Por ejemplo, se considera que existe correlación entre la morfología de esta estructura anatómica y varias patologías; como el síndrome de la silla turca vacía, síndrome de Williams, paladar hendido, entre otras. Objetivo: describir las variaciones anatómicas de la silla turca que se observan en las radiografías laterales de cráneo del Hospital Universitario "Faustino Pérez" de la ciudad de Matanzas, en el período de enero del 2017 a enero del 2018. Materiales y métodos: el universo fue 140 radiografías laterales de cráneo, de estas 85 pertenecieron al sexo femenino y 55 al masculino. Las variables estudiadas fueron edad, sexo y variaciones anatómicas de la silla turca. Se emplearon métodos teóricos y empíricos. Resultados: se observó un predominio de la variación anatómica de la silla turca en forma de U, en ambos sexos. Seguido de la forma de J, predominando la variación en forma de U en el grupo etario de 41 a 50 años y la forma de J en los pacientes mayores de 60 años. Conclusiones: es imprescindible el conocimiento de la anatomía normal de la silla turca y de sus variaciones anatómicas, tanto para las especialidades quirúrgicas como para las no quirúrgicas. Un análisis exhaustivo de la morfología de esta estructura es necesario para establecer parámetros que excluyan determinadas patologías.

ABSTRACT Introduction: several authors declare that sella turcica morphology is a predisposing factor to several diseases. For example, it is considered that there is a correlation between the morphology of this anatomical structure and several pathologies like empty sella turcica syndrome, Williams syndrome, cleft palate and others. Objective: to describe the anatomical variants of sella turcica observed in side cranial radiographies of the University Hospital ¨Faustino Perez¨ of Matanzas, in the period January 2017-January 2018. Materials and methods: the universe was 140 side cranial radiography: 85 belonged to female patients and 55 to male patients. The studied variables were age, sex and sella turcica anatomical variables. Theoretic and empirical methods were used. Results: it was observed a predominance of the U-shaped sella turcica anatomical variant in both sexes, followed by the J-shaped one. The U-shaped form predominated in the 41-50-years-old age-group and the J-shaped form in patients elder than 60 years. Conclusions: it is essential to know sella turcica normal anatomy and its anatomical variables, both for the surgical specialties and for the non-surgical ones. It is necessary the exhaustive analysis of this structure to establish parameters excluding several pathologies.

Investigation of the relationship between "sella turcica bridge" and "ponticulus posticus": a lateral cephalometric study / Investigación sobre la relación entre "puente silla turca" y "ponticulus posticus": un estudio cefalométrico lateral

The ponticulus posticus (PP) is a bridge of bone sometimes found on the atlas vertebra surrounding the vertebral artery and the first cervical nerve root. Sella turcica bridging (STB) is the fusion of anterior and posterior clinoid processes. The objective of this study was to find out the association between STB and PP. For the study, 752 digital lateral cephalograms were retrieved from the archived records of Necmettin Erbakan University, Faculty of Dentistry, Konya, Turkey. There was a significant relationship between the presence of STB and PP (p=0.000, p<0.001). This study indicates that there is a significant correlation between the presence of STB and PP.

El Ponticulus Posticus (PP) es un puente de hueso que se encuentra, a veces, en el atlas y rodea la arteria vertebral y la primera raíz del nervio cervical. El puente de la silla turca (PST) es la fusión de los procesos clinoides anteriores y posteriores. El objetivo de este estudio fue conocer la asociación entre PST y PP. Para el estudio, fueron utilizados 752 cefalogramas digitales laterales, obtenidos de los registros archivados de la Facultad de Odontología de la Universidad Necmettin Erbakan, Konya, Turquía. Hubo una relación significativa entre la presencia de PST y PP (p = 0,000, p <0,001). Este estudio indica que existe una correlación significativa entre la presencia de PST y PP.

Assessment and comparison of dimensions of sella turcica in skeletal class I and skeletal class II Cases

The aim of this study was to assess and compare the dimensions of Sella Turcica in 90 subjects grouped as Group A [Skeletal Class I:ANB0-4°, Wits value -1 to 0.5 mm][1.4] and Group B [Skeletal Class II:ANB>4°, Wits value >0.5 mm] aged 14-30 years each having 45 subjects. For Group A Width [W] of Sella Turcica[10] is found to be 15.33 mm + 2.77 S.D, Depth [D] 6.43 mm + 1.45 S.D, Area [A] 66.05 mm[2] + 9.2 S.D, Specific Dimension [SDim] 99.5 mm[2] + 27.7 S.D and Interclinoid Distance [I] as 5.55 +2.12 S.D while for Group B Width [W] of Sella Turcica is found to be 14.55 mm+2.16S.D, Depth [D] 6.45 mm+0.9 S.D, Area [A] 60.35 mm[2]+7.96 S.D, Specific Dimension [SDim] 94.4 mm[2]+21.56 S.D and Interclinoid Distance [I] as 4.85 mm+0.93 S.D. When two groups were compared for Sellar Dimensions, Width, Area and Interclinoid Distance showed statistically significant difference between the Skeletal Class II and Skeletal Class I subjects [P<0.05] while Vertical Depth and Specific Dimension showed statistically insignificant difference [P>0.05]. Moreover these findings appear to indicate the greater likelihood of Sella Turcica bridging in Skeletal Class II patients

Multiparity as a risk factor inducing pituitary function failure in the elderly

Hypopituitarism is difficult to diagnose in eldery people. The presentation usually are non specific with symptoms such as lethargy, pallor, falls, urinary incontinence, confusion, fever and even coma. Hormone replacement therapy resulted in improving quality of life [1,2]. Physicians dealing with elderly patients should bear this easily treated condition in mind. Prompted by striking features in four females, all over 60 years admitted to ourhospital with unexplained lethargy, altered state of consciousness and loss or diminished pubic hair with normal obstetric history but gravida more than 7. Pituitary assessment was done which proved hypopituitarism in all the 4 cases. This attracts our attention to study the relation between multiparity and pituitary dysfunction. Patients and methods: This study was a semiprospective study, over 7 years between June1992 till April 2000. The study included 22 female patients, age between 60-79 years with parity ranged from 4-13 with the majority of cases [91%] have parity more than 5. The control group included 20 females of same age group but nullipara or have one parity only. All were admitted to the hospital due to unexplained lethargy, generalized weakness and altered sensorium. Endocrine disturbance was clinically suspected. Thorough physical examination and history was taking emphasizing on the obstetric history. Hormonal assay [RIA], LH, FSH, estradiol, cortisol, TSH, T3, FT4, ACTH and prolactin were measured, 800am along with Na and k.CT brain and /or MRI were done for pituitary glands. Hormonal assay showed statistically low mean level of LH, FSH in the multiparous group compared to the control group [P<0.01]. TSH was normal in both groups, while T3, FT4, estradiol and cortisol were slightly lower than the control but the difference was not statistically significant except for estradiol and cortisol. Similar results were found as regards ACTH and prolactin. MRI showed empty sella in the majority of multiparous group 15 cases [68%], while only in 5 cases [25%] of the control group. The difference was significant. Final clinical diagnosis, showed definite pituitary dysfunction in majority of multiparous group, 12 cases had hypogonadotrophine associated with secondary hypothyroid in 4 cases, or with secondary hypoadrenalism in 4 cases, three cases have hypopituitarism, one case with hyperprolactinemia and two cases with SIADH syndrome and three cases have normal hormonal assay in spite of some clinical signs suggesting hormonal deficiency. Control group had much less hormonal disturbance, only one case has hypogonadotrophine, one case has hyperprolactinemia and one case with primary hypothyroid. We found definite relation between number of parity and pituitary dysfunction, the risk ratio was 4.1, [95% CI 1.7-9.5]. We recommend that physician dealing with elderly patients should consider the possibility of hypopituitarism in ill elderly grand multipara female patients, when no obvious diagnosis can explain their conditions, especially if signs of hormonal disturbance were detected as absent or diminisihed pubic hair, pallor and buffy face. Hormonal study must done for these patients