Anatomical considerations in acromegalic patients: A multicentric cohort study

Changes in craniofacial morphology due to elevated levels of growth hormone (GH) vary according to ethnic groups studied in the international literature. We aimed to evaluate the radiologic and endoscopic anatomical variations in acromegalic patients, in comparison with non-functioning pituitary adenomas (NFPA) in the Mexican population.

One hundred and fifteen patients with endocrinologically and histologically confirmed diagnosis of GH-secreting pituitary adenoma (PA) and NFPA, treated only by endoscopic endonasal approach, in ten different institutions in Mexico, were studied over a 1-year period. Hormonal levels of GH, somatomedin, preoperative neuroimaging, and intraoperative endoscopy were analyzed to evaluate morphological changes specific to the Mexican population.

A higher number of GH-producing macroadenomas was obtained for this study (69.2%), which was directly related to the hypertrophy of the turbinate mucosa in 63.5% (P = 0.003), the presence of enlarged ethmoid sinuses corresponded to 43% (P = 0.04) in GH-secreting PA higher than NFPA. In the endoscopic view, the presence of occult ostium was <25% and the identification of the carotid eminence was >75% of the cases for both groups. The highest levels of GH levels were found in macroadenomas, but they had no significant relationship with the presence of hidden ostium or the hypertrophy of the turbinate mucosa. The rest of the measurements were very similar between both groups.

Mexican acromegalic patients present subtle morphological changes that can affect the safety and efficacy of the endonasal approach, primarily in the nasal and sphenoid phases.