SAT-095 - Sellar Spine in Children and Young Adults: Imaging Features and Endocrine Outcomes

Background: Sellar spine is a rare anatomic variant of the dorsum sellae. Data describing sellar spine in children and young adults are limited, and its true clinical significance remains uncertain. We aimed to describe clinical presentation and associated pituitary dysfunction among children and young adults with sellar spine identified before age 25 years.

Methods: We retrospectively reviewed patients with sellar spine identified on brain imaging performed at < 25 years of age. Extracted variables included age at initial and most recent brain imaging, indication for imaging at lesion discovery, and pituitary dysfunction status and type.

Results: Eleven patients were included, with age at initial identification of a sellar spine ranging from 6.0 to 24.0 years. Indications for neuroimaging were heterogeneous and included headaches (n=4), seizures (n=2), concerns for precocious puberty (n=2), suspected stroke/ataxia (n=1), nasal polyp evaluation (n=1), and concern for a pituitary adenoma (n=1). Sellar spine anteroposterior (AP) size ranged from 1.5 to 7.0 mm, with an AP size-to-sella ratio ranging from 0.25 to 0.75. Seven patients had pituitary stalk deviation from the sellar spine. In two patients, the sellar lesion led to pituitary gland distorted morphology leading to a misdiagnosis of pituitary adenoma. Neither sellar spine size nor AP size-to-sella ratio was associated with endocrinopathies. 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: Caution should be exercised in the interpretation of sellar imaging, as the presence of a sellar spine can distort pituitary anatomy and result in diagnostic misclassification. Endocrinopathies may happen in some patients with sellar spine. Further, larger studies are warranted to better define the characteristics of sellar spine leading to endocrinopathies.

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