ReviewEndocrine connections2025
Carotid artery constriction in autoimmune hypophysitis: three case reports and literature review.
Review in Endocrine connections, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Objective: An intracavernous internal carotid artery constriction or occlusion (ICAc/o) has been considered an extremely rare finding in autoimmune hypophysitis (AiHy). This study aimed to analyse predictive factors for the occurrence of ICAc/o in AiHy. Design: Retrospective analysis of three of our own cases and 16 published cases. Methods: Among 15 surgically treated patients with AiHy, we identified three cases with ICAc/o via time-of-flight magnetic resonance angiography (TOF MRA) or computed tomography angiography (CTA). In addition, 16 published cases with AiHy and ICAc/o were identified via the literature search. Clinical features, treatment, and outcomes were evaluated. Results: TOF MRA revealed complete bilateral ICA occlusion (ICAo) in case 1 and incomplete bilateral ICA constriction (ICAc) in case 2. In the third case, left-sided ICAo was confirmed by CTA. None of our three patients with AiHy complicated by ICAc/o suffered brain infarction or neurological deficits. All three cases exhibited a parasellar T2 dark sign and strong dural enhancement. With our three cases included, seven of 19 published cases (36.8%) showed complete bilateral ICAo. Among these, four presented with ischaemic stroke. Eight of 19 patients (42.1%) presented with cranial nerve palsy. While all patients presented with hypopituitarism, only five had arginine vasopressin (AVP) deficiency. Interestingly, 11 patients had a recurrent course of hypophysitis. Conclusion: ICAc/o caused by AiHy appears to be more frequent than previously reported. Special attention should be paid to the carotid arteries in AiHy because of the potentially deleterious complication of ICAc/o. Cranial nerve palsy, a parasellar T2 dark sign, strong perisellar dural enhancement, and a recurrent course of hypophysitis can be considered warning signs of the occurrence of ICAc/o.
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