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Herniation of cerebellar tonsils in acromegaly: prevalence, pathogenesis and clinical impact

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Abstract

Herniation of cerebellar tonsils (CTH) might occur in acromegaly patients and improve after acromegaly treatment. Our study investigated CTH prevalence in acromegaly, its relationship with clinical, laboratory and neuroimaging findings and its possible pathogenesis and clinical impact. 150 acromegaly patients (median-age 56 years, age-range 21–88, 83 females) underwent brain magnetic resonance imaging (MRI). Clinical data, laboratory and pituitary adenoma imaging findings were recorded. CTH, posterior cranial fossa area, tentorial angle, clivus, supraocciput and Twining’s line length were measured in acromegaly patients and controls, who included MRI of 115 consecutive subjects with headache or transient neurological deficits (control group-1) and 24 symptomatic classic Chiari 1 malformation patients (control group-2). Acromegaly patients were interviewed for symptoms known to be related with CTH. 22/150 acromegaly patients (15 %) and 8/115 control group-1 subjects presented with CTH (p = 0.04). In acromegaly patients, CTH correlated positively with younger age and inversely with GH-receptor antagonist treatment. Control group-2 had a shorter clivus than CTH acromegaly patients (40.4 ± 3.2 mm vs 42.5 ± 3.3 mm, p < 0.05), while posterior fossa measures did not differ among acromegaly subgroups (with and without CTH) and control group-1. Headache and vision problems were more frequent in CTH acromegaly patients (p < 0.05); two acromegaly patients presented with imaging and neurological signs of syringomyelia. Despite no signs of posterior fossa underdevelopment or cranial constriction, CTH is more frequent in acromegaly patients and seems to contribute to some disabling neurological symptoms.

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Conflict of interest

All the authors declare that they have no conflict of interest in connection with this paper.

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Authors and Affiliations

  1. Neuroradiologic Unit, University Hospital of Padua, Via Giustiniani 5, 35138, Padua, Italy

    Renzo Manara, Giulia Bommarito & Valentina Citton

  2. Department of Medical and Surgical Sciences, University Hospital of Padua, Via Giustiniani 5, 35138, Padua, Italy

    Silvia Rizzati, Franco Mantero & Carla Scaroni

  3. Department of Neurosciences, University Hospital of Padua, Via Giustiniani 5, 35138, Padua, Italy

    Chiara Briani, Alessandro Della Puppa & Mario Ermani

  4. Internal Medicine 3, Department of Medical and Surgical Sciences, University Hospital of Padua, Via Giustiniani 5, 35138, Padua, Italy

    Eva Zanchetta, Chiara Martini, Nicola Sicolo & Pietro Maffei

  5. Radiology Division, OC San Bassiano, Bassano del Grappa, Italy

    Fabio Zerbo

Authors
  1. Renzo Manara
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  2. Giulia Bommarito
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  10. Chiara Martini
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  14. Carla Scaroni
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Corresponding author

Correspondence to Valentina Citton.

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Dr. Carla Scaroni and Dr. Pietro Maffei, should be considered as "senior co-authors".

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Manara, R., Bommarito, G., Rizzati, S. et al. Herniation of cerebellar tonsils in acromegaly: prevalence, pathogenesis and clinical impact. Pituitary 16, 122–130 (2013). https://doi.org/10.1007/s11102-012-0385-9

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  • DOI: https://doi.org/10.1007/s11102-012-0385-9

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