Sellar spine in children and young adults: clinical presentation, imaging characteristics, and pituitary outcomes

OBJECTIVES: The true clinical relevance of a sellar spine remains unclear because of limited available data. We aimed to describe the presentation and associated pituitary dysfunction among children and young adults with a sellar spine. METHODS: We retrospectively reviewed patients with a sellar spine found on brain imaging obtained in individuals less than 25 years of age. Extracted variables included age at initial brain imaging, indication for imaging, and pituitary dysfunction status and type. RESULTS: Eleven patients were included. Age at initial identification of a sellar spine ranged from 6 to 24 years. Indications for neuroimaging included headaches (n=3), seizures (n=2), precocious puberty (n=1), severe obesity with advanced bone age (n=1), suspected stroke/ataxia (n=1), nasal polyp evaluation (n=1), hypogonadotropic hypogonadism and secondary hypothyroidism (n=1), and as part of screening testing for Von Hipple Lindau (n=1). Pituitary stalk deviation was found in 7 patients (63.6 %). Pituitary gland distorted morphology leading to a misdiagnosis of pituitary adenoma found in 2 patients (18.2 %). Among younger children (n=5; age ≤9 years), precocious puberty occurred in one patient who demonstrated pituitary stalk deviation with an AP size-to-sella ratio of 0.5. Another child with stalk deviation did not develop precocious puberty. Pituitary hormone deficiency was identified in one patient (hypogonadotropic hypogonadism and hypothyroidism) with stalk deviation and AP size-to-sella ratio of 0.63. CONCLUSIONS: The presence of a sellar spine can distort pituitary anatomy and result in diagnostic misclassification. Endocrinopathies may develop in some affected patients. Further, larger studies are warranted to better define the characteristics of sellar spine leading to endocrinopathies.