Pituitary enlargement in patients with cerebrospinal fluid drainage due to ventricular shunt insertion: know the condition and do not mistake for adenoma
Authors' conclusion
Our results confirmed a significant increase in pituitary size and volume, mimicking pituitary pathology, after v.-p. shunt insertion. This phenomenon can be explained by the Monro-Kellie doctrine, stating that intracranial depletion of CSF-as caused by v.p. shunting-leads to compensatory intracranial hyperemia, especially in the venous system, with the consequence of engorged venous sinuses, most likely responsible for enlargement of the pituitary gland.
Study context
- Population
- Shunted (ventriculo-peritoneal) hydrocephalus patients with radiological signs of high cerebrospinal fluid (CSF) drainage
- Exposure
- Shunted hydrocephalus patients vs population mean
- Non-tumoral hydrocephalusn = 15
- Brain tumor hydrocephalusn = 7
- Outcome
- Pituitary size and morphology
Main finding
As reported in the abstract
T (midsagittal size)
5.91
P < 0.001
Both hydrocephalus groups
T (pituitary volume)
3.03
P = 0.006
Both hydrocephalus groups
Observational data: associations, not effects.
Further findings
| Outcome | Preoperative (midsagittal height) | Post-surgery (midsagittal height) | Preoperative (volume) | Post-surgery (volume) |
|---|---|---|---|---|
| Pituitary size and volume pre- vs postoperatively (5 brain tumor patients) · pre- vs post-surgery | mean 2.54 ± 1.0 mm | mean 6.6 ± 0.7 mm | mean 120.5 ± 69.2 mm³ | mean 368.9 ± 57.9 mm³ |
Pituitary size and volume pre- vs postoperatively (5 brain tumor patients) · pre- vs post-surgery
- Significant increase in pituitary size and volume postoperatively
Original publication
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