Aneurisma gigante de carótida interna simulando macroadenoma de hipófise

Borges, Fabiano Zaidan; Ferreira, Béatriz; Resende, Elisabete Aparecida Mantovani Rodrigues de; Neto, Ezequiel N.; Borges, Wilson; Oliveira, Ricardo Santos; Borges, Maria de Fátima

doi:10.1590/s0004-27302006000300020

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…After the aneurism surgical decompression serum prolactin levels returned to normal. Thereafter, a number of new cases were reported over the subsequent years (6,8,9,(15)(16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

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Severe hyperprolactinemia associated with internal carotid artery aneurysm: differential diagnosis between prolactinoma and hypothalamic-pituitary disconnection

Duarte

Machado

Lima

et al. 2008

Arq Bras Endocrinol Metab

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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. Massas selares e parasselares podem produzir hiperprolactinemia por bloquear o tônus inibitório hipotalâmico de dopamina. uma destas condições, raramente reportada, é o aneurisma de artéria carótida interna causando compressão da haste hipofisária e hiperprolactinemia, a maioria com pequenas elevações da prolactina. o objetivo deste estudo é descrever o caso de uma paciente com aneurisma de carótida interna e grave hiperprolactinemia. Paciente feminina, 72 anos, em acompanhamento oncológico por carcinoma de colo de útero clinicamente controlado, avaliada por causa da piora de cefaléia crônica. durante investigação, tomografia computadorizada e ressonância magnética (rM) de hipófise mostraram massa selar associada com altos níveis de prolactina (1.403 µg/l), sendo avaliado como macroprolactinoma e tratado com bromocriptina. entretanto, rM subseqüente sugeriu aneurisma de carótida interna que foi confirmado por angiorressonância de vasos cerebrais. em uso de baixas doses de bromocriptina (1,25 mg/dia), houve pronta normalização da prolactina com grande elevação (> 600 µg/l) após a retirada do medicamento, sendo confirmado por várias vezes sugerindo dHH. reporta-se uma paciente com aneurisma de artéria carótida interna com grave hiperprolactinemia, nunca descrita anteriormente em pacientes com dHH, e a necessidade do diagnóstico diferencial com macroprolactinoma, mesmo considerando altos níveis de prolactina. Descritores: Hiperprolactinemia; Aneurisma de artéria carótida interna; desconexão hipotálamo-hipofisária; Prolactinoma; diagnóstico diferencial de tumor hipofisário

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Section: Discussionmentioning

confidence: 99%

“…Serum prolactin levels ranged between 4 and 182 µg/L (5,6,8,9,16,17,(19)(20)(21) associated with hypopituitarism. Clinically, the most common complaints were headaches and blurred vision attributed to the mass effect.…”

Section: Discussionmentioning

confidence: 99%

Severe hyperprolactinemia associated with internal carotid artery aneurysm: differential diagnosis between prolactinoma and hypothalamic-pituitary disconnection

Duarte

Machado

Lima

et al. 2008

Arq Bras Endocrinol Metab

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Carotid Artery Aneurysm

2013

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Giant, thrombosed, sellar–suprasellar internal carotid artery aneurysm with persistent, primitive trigeminal artery causing hypopituitarism

et al. 2011

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A rare case of a giant, thrombosed, sellar-suprasellar paraclinoid internal carotid artery (ICA) aneurysm with persistent primitive trigeminal artery (PPTA) causing hypopituitarism that manifested as hypogonadism, hypothyroidism, and hypocortisolism is reported. There were no visual/neurological deficits, diabetes insipidus, or episodes of subarachnoid hemorrhage. The alteration in the flow dynamics of the circle of Willis due to the presence of PPTA may have been responsible for both the genesis of the giant aneurysm as well as for the induction of thrombogenesis within its lumen. As the digital subtraction angiogram showed complete thrombosis within the aneurysm and hormonal replacement therapy was effective in ensuring complete normalization of symptoms, the patient was unwilling to undergo surgical clipping of the aneurysm and removal of the suprasellar clot in an attempt to restore pituitary functions. Hypopituitarism recurred when the patient stopped her hormonal supplementation therapy after 7 years, and she again became symptom-free on restarting the therapy. To the best of the authors' knowledge, this represents the first reported case in the literature of hypopituitarism consequent to a giant, thrombosed, sellar-suprasellar ICA aneurysm with an associated PPTA on the side of the aneurysm.

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Aneurisma gigante de carótida interna simulando macroadenoma de hipófise

Cited by 6 publications

References 14 publications

Severe hyperprolactinemia associated with internal carotid artery aneurysm: differential diagnosis between prolactinoma and hypothalamic-pituitary disconnection

Severe hyperprolactinemia associated with internal carotid artery aneurysm: differential diagnosis between prolactinoma and hypothalamic-pituitary disconnection

Carotid Artery Aneurysm

Giant, thrombosed, sellar–suprasellar internal carotid artery aneurysm with persistent, primitive trigeminal artery causing hypopituitarism

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