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Dr. Schupack, let's talk about pituitary gland

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size and a little bit on shape.

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The pituitary gland has been...

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and fossa has been described as a Turkish saddle.

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And the gland can be kind of curved this way,

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convex downward,

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but I don't mind if it's flat and I don't

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mind if it's slightly convex upward.

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Those are all okay as long as there's no other criteria like

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a focal defect, an enhancement abnormality,

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mass effect, effacement of the central vascular pituitary tuft

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to the midline to one side or the other.

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Focality.

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Eccentric focality does matter,

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but measuring the gland size is something that people

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often wonder about. I personally, for years,

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have been measuring the gland size in the coronal

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projection, not at the level of the pars tuberalis,

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but slightly behind it at the level of the

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pituitary stalk from here to here.

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But actual measurements that are anatomic

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are taken in the sagittal projection,

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so you should probably do it in both planes.

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And this individual, when we measure from here to here,

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this is a young, healthy female,

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it's about 7 mm.

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So what are normal size ranges based on physiology and age?

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Yeah, I do provide,

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when I'm doing a sella,

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I do provide a measurement of the pituitary

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height because it's very important

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to find out where the patient fits in the range in reference

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to the age and sex, which is going to vary.

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So the largest measurement is going to

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be in a young female aged 22 to 32.

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And the average gland size may be about 7 mm,

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plus or minus one. Okay?

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Male, in that same age group,

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a little bit smaller,

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about millimeter smaller on average.

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Okay? And so, that's going to be the peak,

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that 22 to 32, for both the male and female,

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but female is going to be a little bit bigger than the male.

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Okay?

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So it's very important to know that because there

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are things that will make the pituitary big.

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And the question is, is it too big or is it normal?

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Well, for example, a tumor within the pituitary,

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but also other conditions such as

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that will hypertrophy the gland.

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Like anorexia nervosa or thyroid hypothyroidism,

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for sure, would be your big one.

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And that is real important because that's a classic

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neurosurgery board question. Big sella...

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big pituitary,

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and they want to make you operate on it.

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And if you didn't check the thyroid,

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you failed that question.

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Basically, pituitary hypertrophy.

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Hypertrophy, secondary to end organ disturbance.

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Now, if you look,

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I have a chart on my desk so that I can provide that

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measurement on each sella case that I look at.

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And those, if you look in the article itself,

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they're usually using this sagittal

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view to provide that measurement.

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Because...

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And that has an advantage because it allows you

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to see where you are anterior and posterior.

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So I like, Dr. Pomeranz, take two measurements,

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and kind of triangulate a little bit,

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but I think if you don't do the sagittal, you're maybe a little

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bit subject to error because of that,

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you know, where you are in the gland,

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what part of the gland you're measuring

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is very important.

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So smack dab right in the middle of the anterior portion

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of the pituitary gland.

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Yeah, you want to be in the anterior portion of the gland.

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Yeah, the pars distalis.

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And of course, the gland can get bigger in pregnancy,

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in pubertal patients, you know,

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it can get up to 11, 12 or even 13 mm

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in some of those physiologic events.

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Let's move on, shall we?