The temporal association of sphenoid sinus mucosal thickening on MR imaging with pituitary apoplexy

Pituitary apoplexy is an infrequent but potentially devastating complication in patients with pituitary adenomas. Previous studies have cited an association between MR visualized sphenoid sinus mucosal thickening and apoplexy. However, uncertainties still remain on the significance and temporal association of this finding with pituitary apoplexy. We provide a clinical study that better delineates this temporal association and also provides histopathologic data for sinus thickening compared to control subjects.

We report on two patients who received serial MR scans leading to the diagnosis of pituitary apoplexy. Patient 1 demonstrated new sphenoid sinus mucosal thickening with the onset of apoplexy. Patient 2 had progressive thickening of sphenoid sinus mucosa from presentation to repeat scanning demonstrating apoplexy. Both patients underwent transsphenoidal resection of their pituitary adenomas with pathology demonstrating inflamed sphenoid sinus mucosa.

Sphenoid sinus mucosal thickening, as demonstrated on MRI, is temporally associated with pituitary apoplexy, likely as an acute and precedent finding.