Carotid cavernous aneurysm presenting as pituitary apoplexy

Romano, Alberto; Chibbaro, Salvatore; Marsella, M.; Ippolito, Sonia; Benericetti, E.

doi:10.1016/j.jocn.2005.05.022

Cited by 15 publications

(12 citation statements)

References 23 publications

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“…No vascular abnormality surrounding and inside the tumor was observed on MR angiograms in all patients. 24 Intraoperative findings relating to intratumoral hemorrhage were observed in 10 of the 25 patients: cysts including xanthochromic fluid in 3, liquefied hematoma (reddish or brownish fluid) in 4, and coagulation (coagulated hematoma, or tumor tissue marbled small coagulated hematomas) in 3 patients. Histologic evidence of intratumoral hemorrhage was clearly observed in 16 patients: 2 patients with significantly present (ϩϩ) and 14 with clearly present (ϩ) hemorrhage.…”

Section: Resultsmentioning

confidence: 95%

“…Intrasellar vascular abnormalities associated with pituitary macroadenoma may be extremely rare. 24 Intraparenchymal large hematomas appear as several different patterns regardless of the age of the hematoma. The most common appearance of a "dark rim," "low signal intensity rim," or "peripheral signal intensity loss" can be explained as the "boundary effect," based on differences in magnetic susceptibility at the border of tissues and by the deoxygenation of blood occurring in the interdigitation of blood and tissue at the periphery of the lesion.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Hemorrhage in Pituitary Macroadenoma by T2*-Weighted Gradient-Echo MR Imaging

Tosaka¹,

Sato²,

Hirato³

et al. 2007

American Journal of Neuroradiology

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Section: Resultsmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Assessment of Hemorrhage in Pituitary Macroadenoma by T2*-Weighted Gradient-Echo MR Imaging

Tosaka¹,

Sato²,

Hirato³

et al. 2007

American Journal of Neuroradiology

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“…Coincidence of intracranial aneurysm and pituitary adenoma had been reported previously [4,8,15,25,[33][34][35][36][37][38][40][41][42]. Some series demonstrated an increased incidence of aneurysm in patients with pituitary adenoma [15,40].…”

Section: Discussionmentioning

confidence: 88%

Overview of vascular complications of pituitary surgery with special emphasis on unexpected abnormality

et al. 2009

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Arterial bleeding during transsphenoidal surgery for pituitary adenoma is known complication. This usually happens due to rupture of intracavernous carotid or delayed hemorrhage due to the carotico-cavernous fistula and/or pseudoaneurysm. There is also evidence that cavernous carotid aneurysms may occur with pituitary tumors, yet largest series failed to demonstrate any link between aneurysm formation and pituitary tumors. Usually such an aneurysm rupture results in formation of carotico-cavernous fistula. However, pituitary apoplexy and even epistaxis have been reported. In this paper we present a patient with recurrent pituitary adenoma and cavernous carotid artery aneurysm, which caused significant hemorrhage during the surgery. Although retrospective analysis of MRI disclosed that the patient had the aneurysm before the first surgery, it remained silent until the second operation. Therefore neurosurgeons should be very susceptive to any signal changes on preoperative MR images, especially in recurrent cases, where normal anatomical relations are disturbed by fibrotic tissue. Also, we reviewed the vascular complication of pituitary surgery based on the literature.

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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%

“…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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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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Carotid cavernous aneurysm presenting as pituitary apoplexy

Cited by 15 publications

References 23 publications

Assessment of Hemorrhage in Pituitary Macroadenoma by T2*-Weighted Gradient-Echo MR Imaging

Assessment of Hemorrhage in Pituitary Macroadenoma by T2*-Weighted Gradient-Echo MR Imaging

Overview of vascular complications of pituitary surgery with special emphasis on unexpected abnormality

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

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