Pituitary dysfunction from an unruptured ophthalmic internal carotid artery aneurysm with improved 2-year follow-up results: A case report

Abstract

<jats:title>Abstract</jats:title><jats:p>Internal carotid artery (ICA) supraclinoid segment aneurysms extending into the sellar region and leading to pituitary dysfunction are a rare occurrence. To date, long-term follow up of pituitary function 2 years post-treatment has never been reported. Herein, we present a case of pituitary dysfunction due to an unruptured ophthalmic segment internal carotid artery aneurysm and report improved 2-year follow-up results. A 76-year-old male presented with disturbed consciousness due to hyponatremia, which was caused by hypoadrenocorticism resulting from pituitary dysfunction complicated by hypogonadism and hypothyroidism. Computed tomography angiography revealed an intracranial aneurysm of the ophthalmic segment of the right ICA with an intrasellar extension. Thus, digital subtraction angiography and coil embolization were performed, followed by hormone replacement therapy. A 2-year follow-up revealed a partial improvement in the pituitary function, including complete restoration of thyroid-stimulating hormone level and other thyroid hormones levels, and partial restoration of testosterone levels, followed by discontinuation of thyroid hormone replacement therapy. However, the mechanisms of such pituitary dysfunction and the effects of various treatments, including clipping and coiling, on different hormones of pituitary function recovery remain unclear. A long-term follow-up of &gt;2 years may elucidate the pituitary function recovery post-treatment and provide a medication adjustment for hormone replacement therapy.</jats:p>

Panhypopituitarism caused by an unruptured giant cavernous internal carotid artery aneurysm compressing the pituitary gland treated with a flow-diverting stent: A case report

“…Open surgical procedures, such as clipping, proximal carotid ligation with high- or low-flow bypass, and endovascular therapy such as coiling and flow-diverting stent deployment, can improve hypopituitarism due to cerebral aneurysms [ Table 1 ]. [ 2 , 4 , 5 , 7 , 9 , 11 ] The time to functional improvement of the gland following treatment ranges from a minimum of 2 months to a maximum of 2 years. [ 5 , 7 , 9 ] In addition to our patient, two other cases of cerebral aneurysms with hypopituitarism treated with flow-diverting stent deployment have been reported.…”

“…[ 2 , 4 , 5 , 7 , 9 , 11 ] The time to functional improvement of the gland following treatment ranges from a minimum of 2 months to a maximum of 2 years. [ 5 , 7 , 9 ] In addition to our patient, two other cases of cerebral aneurysms with hypopituitarism treated with flow-diverting stent deployment have been reported. One showed functional improvement of the pituitary gland at 10 months after treatment, and the other showed no improvement at 1 month after treatment.…”

“…Mechanical compression and pulsation of aneurysms, and disruption of microvascular supply can cause hormone depletion. [10] Although functional improvements of the pituitary gland caused by an unruptured intrasellar aneurysm after open surgery or endovascular treatment have been reported, [2,[4][5][6][7]9,11] there have been no reports showing hormonal improvement with a reduction in the aneurysmal mass effect on magnetic resonance imaging (MRI) in cases treated with flowdiverting stent. Here, we described a patient with a giant thrombotic ICA aneurysm causing pituitary impairment which was successfully treated with endovascular deployment using a flow-diverting stent, with subsequent reduction in the mass effect on MRI.…”