Postnatal sellar spine growth

Abstract

Background:A sellar spine is a bony spur protruding anteriorly from the central portion of the dorsum sellae. Its etiology is an ossified notochordal remnant of the cephalic end of the notochord. It is presumed to be a congenital malformation based on magnetic resonance imaging (MRI) findings of sellar spine in a 4-year-old boy. A sellar spine should therefore be detectable at birth with or without ossification, and the posterior pituitary lobe should be displaced.Methods and Results:Here we review the literature and report the first case of typical sellar spine in an 8-year-old girl who presented with precocious puberty, but her MRI taken at age 4 months for a febrile convulsion did not show a sellar spine or posterior pituitary lobe deformation. T1-weighted sagittal images at 8 years old showed a bony structure protruding anteriorly from the central portion of the dorsum sellae. The length of this lesion was 3.8 mm on computed tomography (CT) scanning at 9 years old, and it elongated to 4.7 mm on CT at 12 years old.Conclusions:Based on the present case, we speculate that the sellar spine would be too small to detect early in development and would grow in size after birth. In this case, a sellar spine and precocious puberty were potentially associated due to deformation of the growing pituitary gland.

Incidentally detected sellar spine in a patient with Cushing’s syndrome: a case report

“…Hosokawa et al. 5 reported a case of precocious puberty in an 8-year-old girl with an enlarged pituitary gland and showed a subsequent pressure effect that could have led to detection of the ossified bony spur. Similarly, Matsumoto et al.…”

“…A few published reports described MRI findings of sellar spine. 5 , 7 , 16 – 18 On T1- and T2-weighted MRI, most sellar spines were clearly shown as a hypointense structure protruding into the pituitary posterior lobe. On coronal T1-weighted images, sellar spine typically appears as a black dot surrounded by a hyperintense rim caused by the posterior pituitary bright spot.…”

“…4 In contrast, few cases associated with pituitary hyperfunction, as in the present case, have been reported. Hosokawa et al 5 reported a case of precocious puberty in an 8-year-old girl with an enlarged pituitary gland and showed a subsequent pressure effect that could have led to detection of the ossified bony spur. Similarly, Matsumoto et al 7 reported sellar spine in a 15-year-old boy who showed elevated serum follicle-stimulating hormone and luteinizing hormone levels.…”

“…Most cases of sellar spine are incidentally detected based on radiologic findings, but several studies have described sellar spine and concurrent endocrinopathies or neuro-ophthalmological manifestations such as hypopituitarism or precocious puberty. [4][5][6][7][8][9][10][11] To the best of our knowledge, however, no reports have described sellar spine in a patient with Cushing's syndrome. We herein present a case of incidentally detected sellar spine mimicking a pituitary adenoma on radiologic examinations during the evaluation of a patient with Cushing's syndrome.…”