ArticleAACE endocrinology and diabetes
Unruptured Giant Internal Carotid Artery Aneurysm Compressing the Pituitary Gland Leading to Panhypopituitarism.
Article in AACE endocrinology and diabetes. 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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Abstract
Background/Objective: Internal carotid artery aneurysms are rare and can lead to hypopituitarism due to their mass effect. Hypopituitarism triggered by aneurysmal compression may persist, and postsurgical restoration of pituitary function is challenging, often necessitating long-term hormone replacement therapy. We herein report a case of hypopituitarism caused by intrasellar aneurysm. Case Report: A 77-year-old female with history of left eye blindness, Hashimoto's thyroiditis, and chronic kidney disease presented with nausea, vomiting, malaise, and altered mental status. Physical examination was unremarkable with no visual field or neurologic deficits except for blindness in left eye. The patient was noted to have hyponatremia which prompted checking serum cortisol level and endocrinology consultation. Workup demonstrated secondary adrenal insufficiency with low cortisol and low adrenocorticotropic hormone, central hypogonadism, and secondary hypothyroidism with low serum thyroid-stimulating hormone and low free thyroxine level. Prolactin was mildly elevated, likely due to stalk effect. Imaging revealed 2.3 × 3.1 × 2.3 cm right cavernous carotid aneurysm in the sella extending into the suprasellar cistern. Hydrocortisone therapy was started, and levothyroxine dose was adjusted which improved her mental status. Subsequently, the patient underwent stent-assisted coil embolization after unsuccessful placement of a flow diversion device by neurosurgery. The patient continues to be on hormone replacement therapy. Discussion/Conclusion: Close monitoring of pituitary hormones is required in the context of giant intrasellar aneurysms, given their potential to induce pituitary dysfunction through mass effect. Timely diagnosis and intervention are paramount to prevent fatal outcomes.
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