Fellow Tower Health at Reading hospital Wyomissing, Pennsylvania, United States
Introduction : Internal carotid artery aneurysms extending into the sellar region are a rare phenomenon, comprising only 1-2% of all intracranial aneurysms. Intrasellar aneurysms, while uncommon, can lead to hypopituitarism due to their mass effect, potentially resulting in severe complications such as lethargy, coma, arrhythmia, and even death. Therefore, we must be alert for it in patients with giant intrasellar aneurysm. We herein report a case of hypopituitarism caused by intrasellar aneurysm. Notably, hypopituitarism triggered by aneurysmal compression may persist, and post-surgical restoration of pituitary function poses significant challenges, often necessitating long-term hormone replacement therapy,
Case(s) Description : We report a case of 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. The physical examination was unremarkable. There were no visual field or neurological deficits. She was noted to be chronic hyponatremic and her serum endocrine panel demonstrated secondary adrenal insufficiency with low Cortisol and low-normal adrenocorticotropic hormone, central hypogonadism with low estradiol, low luteinizing hormone and inappropriately normal follicle stimulating hormone in a postmenopausal female. The patient was also diagnosed with secondary hypothyroidism with low serum thyroid-stimulating hormone and low free thyroxine level. Insulin-like growth factor 1 was also low. Prolactin was mildly elevated which is most likely due to the stalk effect. Imaging workup revealed large 2.3 x 3.1 x 2.3 cm right cavernous carotid aneurysm expanding to the seller region and extending into the suprasellar cistern. Hydrocortisone therapy was started for secondary adrenal insufficiency and her levothyroxine dose was adjusted which improved the patient's mental status and symptoms. Subsequently, the patient underwent a flow-diverting stent placement by neurosurgery, followed by an attempted but unsuccessful coil embolization of the dissecting aneurysm. While complete pituitary function recovery was not achieved at 6 months follow up, there was a positive trend, and hormonal replacement therapy effectively normalized symptoms.
Discussion : 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 associated with hypopituitarism.
