Diagnosis of acromegaly on cranial computed tomography

The characteristic features of acromegaly as demonstrated on cranial computed tomography (CT) are described. These features relate to the increased soft tissue bulk and overpneumatization of sinuses and air cells, as well as the generalized bony overgrowth associated with high growth hormone (GH) levels. In the assessment of these features, the computer window settings must be adjusted accordingly for separate visualization of soft tissues, calvarial bones and cerebral tissue on the scan images. We found positive features in CT scans of 13 patients with established acromegaly and were able to suggest the diagnosis prospectively in 2 additional cases. The finding of an enlarged pituitary fossa should lead the radiologist to search carefully for the ancillary signs of acromegaly on the scans, thus confirming the diagnosis. When an enlarged sella turcica or an enhancing intrasellar mass is not demonstrated, the recognition of the other features on cranial CT scans may be important in suggesting the diagnosis of acromegaly to the clinician.