Endoscopic surgical landmarks requiring presurgical assessment include evaluation for presence of sinus inflammatory disease, sphenoid sinus pneumatization, bony spurs, variant anatomy, and bony dehiscence overlying the internal carotid arteries within the sphenoid sinuses [11-13]. Discussion of Procedures by Variant Variant 1: Adult. Suspected or known hypofunctioning pituitary gland (hypopituitarism, growth hormone deficiency, growth deceleration, panhypopituitarism, hypogonadotropic hypogonadism). Initial imaging. Pituitary hypofunction can be caused by mass effect from extrinsic solid or cystic lesions, or from intrinsic pituitary abnormalities. Small prolactin-secreting adenomas in males may result in hypogonadotropic Department of Defense, or United States Government. Reprint requests to: publications@acr.org Neuroendocrine Imaging hypogonadism, with loss of libido and impotence [14]. Other common mass lesions that may affect the neuroendocrine system are germ-line tumors, meningioma, craniopharyngioma, and Rathke cleft cyst, among others [2,15-18]. Metastatic lesions, sarcoid, and other inflammatory processes may involve the sella and parasellar regions as well. Additionally, an empty sella may be seen with herniation of the subarachnoid space into the sella turcica; while this is usually an incidental finding, close to 30% of patients may demonstrate some hypopituitarism upon testing [19]. CT Sella CT can be used to detect bone-destructive lesions of the skull base, which may affect the sella turcica and can also detect larger macroadenomas. Even with an optimized technique, CT for pituitary pathology is insensitive when compared to MRI [12]. Intravenous (IV) contrast may be useful to characterize lesions or assess for soft-tissue invasion, but it should not be considered a first-line imaging test. CT using dual-energy techniques may discriminate larger pituitary masses from other lesions, such as meningioma [18].
Neuroendocrine Imaging. Endoscopic surgical landmarks requiring presurgical assessment include evaluation for presence of sinus inflammatory disease, sphenoid sinus pneumatization, bony spurs, variant anatomy, and bony dehiscence overlying the internal carotid arteries within the sphenoid sinuses [11-13]. Discussion of Procedures by Variant Variant 1: Adult. Suspected or known hypofunctioning pituitary gland (hypopituitarism, growth hormone deficiency, growth deceleration, panhypopituitarism, hypogonadotropic hypogonadism). Initial imaging. Pituitary hypofunction can be caused by mass effect from extrinsic solid or cystic lesions, or from intrinsic pituitary abnormalities. Small prolactin-secreting adenomas in males may result in hypogonadotropic Department of Defense, or United States Government. Reprint requests to: publications@acr.org Neuroendocrine Imaging hypogonadism, with loss of libido and impotence [14]. Other common mass lesions that may affect the neuroendocrine system are germ-line tumors, meningioma, craniopharyngioma, and Rathke cleft cyst, among others [2,15-18]. Metastatic lesions, sarcoid, and other inflammatory processes may involve the sella and parasellar regions as well. Additionally, an empty sella may be seen with herniation of the subarachnoid space into the sella turcica; while this is usually an incidental finding, close to 30% of patients may demonstrate some hypopituitarism upon testing [19]. CT Sella CT can be used to detect bone-destructive lesions of the skull base, which may affect the sella turcica and can also detect larger macroadenomas. Even with an optimized technique, CT for pituitary pathology is insensitive when compared to MRI [12]. Intravenous (IV) contrast may be useful to characterize lesions or assess for soft-tissue invasion, but it should not be considered a first-line imaging test. CT using dual-energy techniques may discriminate larger pituitary masses from other lesions, such as meningioma [18].