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Cukiert A, Andrioli M, Liberman B, Pimentel F, Goldman J, Nery M , Knoepfelmacher M, Salgado LR.
Serviços de Neurocirurgia e Endocrinologia do Hospital Brigadeiro, São Paulo SP.
The introduction of MRI in clinical practice had enhanced our ability to detect microadenomas pre-operatively. On the other hand, ACTH secreting tumors are still not detected in 20-40% of the patients. We studied the topography of the ACTH-secreting tumors in 20 consecutive patients whose tumors were seen on MRI. The sella was divided in 3 compartments: 2 lateral and 1 median. Twelve patients had microadenomas and 8 macroadenomas. Three of the microadenomas were located in the right lateral compartment, 7 in the left and only 2 in the median. Six of the macroadenomas occupied the entire sella (3 compartments) and 2 occupied 2 contiguous compartments. Three macroadenomas showed imaging signs of cavernous sinus invasion. These findings suggest that macroadenomas are more common than previously thought in patients with Cushing’s disease. Microadenomas were rarely seen in the median compartment. These data do not support the performance of median wedge resections as proposed by others when no tumor was found during surgery.