TORTUOSITY OF THE CAVERNOUS CAROTID ARTERIES CAUSING SELLAR EXPANSION SIMULATING PITUITARY ADENOMA

ABSTRACT: Am 7 Roenigenol 126:1203-1210, 1976 TORTUOSITY OF THE CAVERNOUS CAROTID ARTERIES CAUSING SELLAR EXPANSION SIMULATING PITUITARY ADENOMA RICHARD D. ANDERSON’ Tortuous, medially-displaced cavernous carotid arteries may cause sellar enlarge- ment which simulates pituitary adenoma. Systemic hypertension appears to ac- count for this tortuosity in some cases, while a congenital anomaly is probably responsible in others. Medical position of the carotid sulci may be demonstrated on sellar tomography. Cerebral arteriography provides the correct diagnosis. Surgery, particularly transsphenoidal hypophysectomy, should be avoided in such patients. When skull films demonstrate sellar expansion with an intact lamina dura, pituitary adenoma is the most likely diagnosis. In some instances surgery or radiation therapy has been undertaken without obtaining cerebral arteriography. The variety of other lesions which can cause these sellar changes, among them aneurysms of the internal carotid artery, makes this ap- proach unwise. We wish to report a vascu- lar anomaly which causes sellar enlarge- ment and for which peremptory surgery, particularly transsphenoidal hypophysectomy, could have an unfortunate result. In the following patients, tortuosity and devi- ation of the cavernous carotid arteries into the sellar midline caused sellar expansion which on plain films was indistinguishable from pituitary adenoma. Tomography sug- gested the entity in two cases. Cerebral arteriography was necessary for diagnosis and should be obtained before treatment of suspected pituitary neoplasm. Case I CASE REPORTS This 39-year-old white female was referred by her family physician for evaluation of severe hypertension of 3 years duration. She com- plained of headaches. Her past history in- cluded hysterectomy and bilateral oophorec- tomy for carcinoma of the cervix 13 years prior to admission. On admission her blood pressure was 190/100. Skull films demonstrated that the sella was elongated in the AP dimension, measuring 19.5 mm; the superoinferior dimension was 8 mm. Frontal tomograms demonstrated a convex sellar floor approximately i mm in width. The left carotid sulcus lay 3.5 mm from the midline in the midportion of the sellar floor (fig. IC; more posteriorly the left carotid sulcus grooved the sphenoid 6 mm from the midline (fig. iD). Lateral tomograms demonstrated thinning and posterior displacement of the dorsum with loss of the lamina dura along the inner aspect of the dorsum (fig. iA) and a deep left carotid sulcus ( fig. iB). The posterior clinoid processes were preserved. Estimated sellar volume was 1,170 mm’. Neurological examin ation , including visual fields, was negative. Papilledema was not pres- ent. Vanillylmandelic acid and catecholamine determinations were normal. The patient was thought to have essential hypertension. Although there was no clinical or endocrino- logical evidence of pituitary disease, the sellar changes were consistent with pituitary adenoma. Additional studies were obtained. CT scan with contrast medium was negative. Cerebral arteriography demonstrated that the left cavernous carotid artery was tortuous, slightly ectatic, and extended into the sella within 2 mm of the midline (fig. 2). The left internal carotid at the level of the anterior clinoid was 3 mm from the midline. The right cavernous carotid was also tortuous and Received January 3, 5976; revised February 57, 1976. I Department of Diagnostic Radiology, University of Alabama School of Medicine, Birmingham, Alabama 35233. 1203 Downloaded from www.ajronline.org by 171.243.67.90 on 05/23/23 from IP address 171.243.67.90. Copyright ARRS. For personal use only; all rights reserved

TORTUOSITY OF THE CAVERNOUS CAROTID ARTERIES CAUSING SELLAR EXPANSION SIMULATING PITUITARY ADENOMA

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