Comparative Analysis of Clivus Morphology in Hormone Secreting Pituitary Adenomas, Non-Functioning Pituitary Adenomas, and Normal Patients

Background: This study aimed to investigate anatomical differences in the clivus among patients with hormone-secreting pituitary adenomas (Group 1), non-functioning pituitary adenomas (Group 2), and a normal control group (Group 3), using the normal group as a baseline to identify tumor-related skeletal remodeling. Methods: The dataset included 163 cases: 37 with hormone-secreting pituitary tumors (Group 1), 74 with non-functioning pituitary adenomas (Group 2), and 52 control cases (Group 3). Tumor dimensions were compared between Groups 1 and 2 using independent t-tests. Clivus features were compared across all three groups using one-way ANOVA followed by Tukey’s HSD post hoc tests to assess group differences. Results: Tumor analysis showed that non-functioning pituitary adenomas had significantly larger dimensions than hormone-secreting pituitary adenomas: transverse diameter (2.188 ± 0.916 cm vs. 1.762 ± 0.784 cm, p = 0.018), AP length (p = 0.005), and height (p = 0.048). Clivus morphology also varied across groups. ANOVA revealed significant group differences in Lower Third Width (F = 10.09, p < 0.001) and Sella Dimension (F = 4.69, p = 0.01). Tukey HSD showed that both tumor groups had significantly wider Lower Third Width compared to the normal group (Group 1 vs. 3: mean diff = 0.1176 cm, p = 0.001; Group 2 vs. 3: mean diff = 0.1000 cm, p < 0.001), with no significant difference between the two tumor groups (p = 0.834). Similar trends were observed for Sella Dimension, with both tumor groups differing significantly from controls, but not from each other. Conclusion: Pituitary adenomas are associated with region-specific remodeling of the clivus, particularly in the lower third and sellar region. These changes appear to occur regardless of hormonal activity, likely due to tumor mass effect. Clival measurements on imaging may serve as useful adjuncts in preoperative evaluation and tumor classification. Fig. 1 (A) Clival length from posterior clinoid process to basion. (B) Clivus and sella width measurements. (C) Clival angle between posterior clinoid process to basion and basion to hard palate. (D) Clival pneumatization area Table 1 Comparison of clival measurements Table 2 Statistically significant differences in clivus features Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany