2026 Proffered Presentations
S283: ANATOMIC CONSIDERATIONS IN ACROMEGALIC PATIENTS: A MULTICENTER COHORT STUDY
Elizabeth Escamilla-Chávez, MD1; Misael Salazar-Alejo, MD2; Marcos V Sangrador-Deitos, MD2; Juan L Gomez-Amador, MD3; 1ISSEMYM Medical Center, Toluca, Mexico; 2Department of Neurological Surgery, Centro Médico Zambrano-Hellion, TecSalud, San Pedro Garza García, Mexico; 3National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico city, Mexico
Introduction: Elevated growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels in acromegalic patients result in notable distortions of skull base anatomy. These anatomical changes include hypertrophic nasal turbinates, nasal polyps, reduced intercarotid distance, and sphenoid rostrum thickening. Such distortions require modifications to standard surgical techniques during pituitary surgery. This multicenter cohort study aimed to assess skull base landmark morphology in patients with acromegaly, correlate these anatomical measurements with preoperative hormonal levels, and compare skull base anatomy between acromegalic patients and control subjects without acromegaly.
Methods: This study included patients with endocrinologically and histologically confirmed GH-secreting pituitary adenomas (FPA) and non-functioning pituitary adenomas (NFPA), all treated exclusively via endoscopic endonasal approach (EEA) across ten Mexican institutions during a one-year period. GH and GF-1 levels, preoperative neuroimaging, and intraoperative endoscopic findings were documented to evaluate morphological changes. Anatomical landmark characteristics and dimensions were compared between groups using t-test, Mann-Whitney U test, or chi-squared test; based on variable type and data distribution. Statistical significance was set at p<0.05.
Results: This study included 115 patients, encompassing 51 with FPAs and 64 NFPAs. No significant correlations were observed between GH levels and either occult sphenoid ostium presence (p=0.06) or turbinate mucosa hypertrophy (p= 0.28). Similarly, IGF-1 levels showed no significant correlations with occult sphenoid ostium (p=0.08) or turbinate mucosa hypertrophy (p=0.55). Turbinate mucosa hypertrophy occurred in 63.5% of FPA patients compared to 35.1% in NFPA patients (p=0.003). Enlarged ethmoid sinuses were observed in 43.4% of FPA patients versus 27.3% in NFPA patients (p=0.04). In contrast, several anatomical measurements showed no significant group differences, including median pyriform aperture width (p=0.933), mean distances from pyriform aperture to rostrum (p=0.943), pyriform aperture to sella turcica (p=0.978), and sphenoid rostrum to sella turcica (p=0.603). Endoscopic findings similarly showed no significant differences in occult sphenoid ostium presence (p=0.59) or carotid prominence visualization (p=0.699).
Discussion: The absence of significant differences in key anatomical distances between FPA and NFPA patients suggests that basic skull base architecture remains comparable between these adenoma types. However, the significantly higher prevalence of turbinate mucosa hypertrophy and enlarged ethmoid sinuses in acromegalic patients reinforce the need for a thorough radiological evaluation to plan and personalize surgical treatments for FPA patients. The lack of statistical significance in some comparisons may reflect insufficient statistical power to detect subtle differences. Additionally, the observed trends warrant validation in larger cohorts, which could reveal more robust correlations between anatomical variations and additional clinical variables.
Conclusions: This study revealed both similarities and differences in skull base anatomy between acromegalic and NFPA patients in a Mexican population. While fundamental anatomical characteristics remained comparable, acromegalic patients demonstrated significantly higher rates of turbinate mucosa hypertrophy and ethmoid sinus enlargement. These findings have important implications for preoperative planning and surgical technique modification in endoscopic pituitary surgery for acromegalic patients.