1
|
Wende T, Hamerla G, Quäschling U, Haase A, Meixensberger J, Nestler U. Persistent hyperprolactinemia, transient hypopituitarism, and transient contralateral third nerve palsy after endovascular treatment of an internal carotid artery aneurysm: Case report and review of the literature. SAGE Open Med Case Rep 2020; 8:2050313X20948714. [PMID: 32922793 PMCID: PMC7457645 DOI: 10.1177/2050313x20948714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/15/2020] [Indexed: 11/11/2022] Open
Abstract
Intracranial aneurysms have an estimated prevalence of about 3%. A rare subgroup
are aneurysms of the internal carotid artery that develop medially into the
sellar region. Due to the risk of rupture with subsequent subarachnoid
hemorrhage and of compression of surrounding structures, mechanical occlusion is
advised. Hypopituitarism is not a rare disease and most often related to
pituitary adenoma. Only 0.17% of cases with hypopituitarism are caused by
unruptured intracranial aneurysms. Today, the predominant treatment of these
aneurysms is endovascular coiling or application of flow diverting stents. We
present the case of a 60-year-old female patient, who was treated with
endovascular coiling for a right-sided, intracavernous, incidental internal
carotid artery aneurysm. On postinterventional day 6, she was readmitted with
contralateral third nerve palsy, mild hyponatremia und thyreotropic
insufficiency. The symptoms recovered after anti-edematous treatment with
corticosteroids; only an asymptomatic hyperprolactinemia persisted. To the best
of our knowledge, this is the first case report of transient contralateral
cranial nerve palsy combined with transient hypopituitarism after endovascular
treatment of an internal carotid aneurysm. As treatment we propose
corticosteroids, if necessary in combination with nonsteroidal anti-inflammatory
drugs, in order to inhibit inflammatory reactions of the aneurysm wall
compromising the nearby, partially compressed neural structures.
Collapse
Affiliation(s)
- Tim Wende
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Gordian Hamerla
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Ulf Quäschling
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Amelie Haase
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Ulf Nestler
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
2
|
Lamback EB, Gouveia HR, Bulzico DA. Into the void: a giant aneurysm mimicking a macroprolactinoma. Endocrine 2017; 58:394-395. [PMID: 28889239 DOI: 10.1007/s12020-017-1419-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Hugo Rodrigues Gouveia
- Department of Interventional Radiology, Brazilian National Institute of Cancer, Rio de Janeiro, Brazil
| | - Daniel Alves Bulzico
- Endocrinology Section, Federal Hospital of Lagoa, Rio de Janeiro, Brazil
- Endocrine Oncology Unit, Brazilian National Institute of Cancer - INCA, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Acute confusional syndrome and hypopituitarism produced by a giant aneurysm of internal carotid artery. Am J Med Sci 2012; 346:147. [PMID: 22885625 DOI: 10.1097/maj.0b013e31825c04c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
4
|
Hanak BW, Zada G, Nayar VV, Thiex R, Du R, Day AL, Laws ER. Cerebral aneurysms with intrasellar extension: a systematic review of clinical, anatomical, and treatment characteristics. J Neurosurg 2012; 116:164-78. [DOI: 10.3171/2011.9.jns11380] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Intrasellar aneurysms are rare lesions that often mimic pituitary tumors, potentially resulting in catastrophic outcomes if they are not appropriately recognized. The authors aimed to characterize the clinical and anatomical details of this poorly defined entity in the modern era of neuroimaging and open/endovascular neurosurgery.
Methods
A PubMed literature review was conducted to identify all studies reporting noniatrogenic aneurysms with intrasellar extension, as confirmed by CT or MR imaging and angiography. Clinical, anatomical, and treatment characteristics were analyzed.
Results
Thirty-one studies reporting 40 cases of intrasellar aneurysms were identified. Six patients (15%) presented with aneurysmal rupture. Patients with unruptured aneurysms presented with the following signs and symptoms: headache (61%), visual field cuts/decreased visual acuity (61%), endocrinopathy (57%), symptomatic hyponatremia (21%), and cranial nerve paresis (other than optic nerve) (18%). The most common endocrine abnormalities were hyperprolactinemia and hypogonadism. Eight aneurysms (20%) were diagnosed in conjunction with a pituitary adenoma. Aneurysms could be categorized into 2 primary anatomical groups as follows: 1) cavernous/clinoid segment internal carotid artery (ICA) (infradiaphragmatic) aneurysms with medial extension into the sella; and 2) suprasellar (supradiaphragmatic) aneurysms originating from the ophthalmic segment of the ICA or from the anterior communicating artery, with inferomedial extension into the sella. The mean diameters of infradiaphragmatic and supradiaphragmatic aneurysms were 14.5 and 21.8 mm, respectively. Infradiaphragmatic aneurysms were much more likely to present with endocrinopathy, whereas supradiaphragmatic ones presented more commonly with visual disturbances. Aneurysms with infradiaphragmatic growth were generally treated using either endovascular techniques or surgical trapping and bypass, while supradiaphragmatic aneurysms were more often treated by surgical clipping.
Conclusions
Aneurysms with intrasellar extension typically present due to mass effect on surrounding structures, and they can be classified as infradiaphragmatic cavernous or clinoid segment ICA aneurysms, or supradiaphragmatic ophthalmic ICA or anterior communicating artery aneurysms. Varying approaches exist for treating these complex aneurysms, and intervention strategies depend substantially on the anatomical subtype.
Collapse
Affiliation(s)
- Brian W. Hanak
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel Zada
- 2Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vikram V. Nayar
- 3Department of Neurosurgery, Georgetown University Hospital, Washington, DC; and
| | - Ruth Thiex
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rose Du
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arthur L. Day
- 4Department of Neurosurgery, University of Texas Medical School at Houston, Texas
| | - Edward R. Laws
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
Duarte FHG, Machado MC, Lima JRD, Salgado LR. Severe hyperprolactinemia associated with internal carotid artery aneurysm: differential diagnosis between prolactinoma and hypothalamic-pituitary disconnection. ACTA ACUST UNITED AC 2008; 52:1189-93. [DOI: 10.1590/s0004-27302008000700017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 07/22/2008] [Indexed: 11/22/2022]
Abstract
Sellar and parasellar masses blocking inhibitory hypothalamic dopaminergic tonus can produce hyperprolactinemia. One of these conditions, seldom reported, is internal carotid artery aneurysm causing pituitary stalk compression and hyperprolactinemia, the majority of which is related to small increases in serum prolactin levels. The aim of this study is to report the case of a patient with an internal carotid aneurysm and severe hiperprolactinemia. A 72 years old female patient, on oncology follow-up for clinically controlled cervical carcinoma, was evaluated due to worsening chronic headaches. During the investigation, computed tomography and magnetic resonance imaging (MRI) showed a sellar mass associated with high prolactin level (1.403 µg/L) that initially was considered a macroprolactinoma, and treated with bromocriptine. However, subsequent pituitary MRI suggested an internal carotid aneurysm, which was confirmed by an angioresonance imaging of cerebral vessels. On low bromocriptine dose (1.25 mg/day), there was a prompt normalization of prolactin levels with a great increase (> 600 µg/L) after withdrawal, which was confirmed several times, suggesting HPD. We report a patient with internal carotid artery aneurysm with severe hyperprolactinemia never reported before in patients with HPD, and the need for a differential diagnosis with macroprolactinomas even considering high prolactin levels.
Collapse
|
6
|
Gondim J, Schops M, Ferreira E. Hypopituitarism and amenorrhea- galactorrhea syndrome caused by thrombosis of both internal carotid artery and giant intrasellar aneurysm: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:158-61. [PMID: 15122453 DOI: 10.1590/s0004-282x2004000100029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Giant intra and parasellar aneurysm with a spontaneous thrombosis of internal carotid artery is rare. We report the case of a 34 years old woman presenting a unique giant sellar and parasellar aneurysm associated with hypopituitarism and amenorrhea-galactorrhea syndrome. Computed tomographic scans and magnetic resonance images were suggestive of a sellar tumor with a cystic component. Digital cerebral angiography showed spontaneous thrombosis of a intrasellar and parasellar carotid artery aneurysm and left internal carotid artery in the neck. A transseptal endoscopic biopsy was done and confirmed a thrombosed aneurysm. No other surgical treatment was required in this patient but permanent endocrinological treatment was necessary.
Collapse
Affiliation(s)
- Jackson Gondim
- Department of Neuroendocrinology, Fortaleza General Hospital, Fortaleza, CE, and Department of Neurosurgery, Federal University of São Paulo, SP, Brasil.
| | | | | |
Collapse
|
7
|
Fernández-Real JM, Fernández-Castañer M, Villabona C, Sagarra E, Gómez-Sáez JM, Soler J. Giant intrasellar aneurysm presenting with panhypopituitarism and subarachnoid hemorrhage: case report and literature review. THE CLINICAL INVESTIGATOR 1994; 72:302-6. [PMID: 8043978 DOI: 10.1007/bf00180045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 52-year-old woman was admitted to our hospital presenting with subarachnoid hemorrhage, left ophthalmoplegia, and right hemiparesis. Previous symptoms and signs suggested the presence of panhypopituitarism. A giant intracranial aneurysm of the internal carotid artery, diagnosed by magnetic resonance imaging, showed the characteristic flow void phenomenon with black appearance. Analysis of endocrine function disclosed panhypopituitarism and hyperprolactinemia. After proximal balloon occlusion of the aneurysm, diabetes insipidus developed. Pituitary function reassessed 6 months after initial admission confirmed anterior and posterior hypopituitarism and hyperprolactinemia. Possible mechanisms are discussed. A review of the literature on pituitary dysfunction caused by carotid artery aneurysms discloses that the pituitary-gonadal axis is the most frequently involved (67.5% of cases), followed by the pituitary-adrenal axis (48.6%) and the pituitary-thyroid axis (40.5%). These frequencies are very similar to those described in other types of hypopituitarism.
Collapse
Affiliation(s)
- J M Fernández-Real
- Department of Endocrinology, Ciutat Sanitària de Bellvitge, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|