Pituitary macroadenoma co-existent with supraclinoid internal carotid artery cerebral aneurysm: a case report and review of the literature

Wang, Chia-Sheng; Yeh, Tsung-Chih; Wu, Tai-Ching; Yeh, Chao‐Hung

doi:10.4076/1757-1626-2-6459

Cited by 13 publications

(7 citation statements)

References 18 publications

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“…Antiplatelet therapy is generally not required and this intervention has been shown to provide aneurysm protection with low morbidity and facilitate transsphenoidal resection of the adenoma. 10,18,[22][23][24][25][26] The rare cases of aneurysms are not amenable to coiling for which urgent decompression of the adenoma is necessary, typically due to macroadenomas with suprasellar extension and vision loss or pituitary apoplexy, a transcranial approach with simultaneous tumor resection and clipping of the aneurysm may be indicated. 15,16,27,28 While endoscopic endonasal intracranial clipping of cavernous carotid aneurysm has been reported and is technically feasible, simultaneous endonasal pituitary adenoma resection and aneurysm has not been performed to the best of our knowledge.…”

Section: Discussionmentioning

confidence: 99%

Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review

et al. 2021

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Introduction Pituitary adenomas are a common intracranial pathology with an incidence of 15 to 20% in the population while cerebral aneurysms are less common with a prevalence of 1:50 patients. The incidence of aneurysms in patients with pituitary adenoma has been estimated at 2.3 to 5.4% of patients; however, this remains unclear. Equally, the management of concomitant lesions lacks significant understanding. Methods A case report is presented of a concomitant cerebral aneurysm and pituitary adenoma managed by minimally invasive endovascular and endoscopic methods, respectively. A systematic review of the literature for terms “pituitary adenoma” and “aneurysm” yielded 494 studies that were narrowed to 19 relevant articles. Results We report a case of a 67-year-old patient with an enlarging pituitary macroadenoma, cavernous carotid aneurysm, and unilateral carotid occlusion. After successful treatment of the aneurysm by a pipeline flow diverter, the pituitary adenoma was surgically resected by an endoscopic transsphenoidal approach. Conclusion The use of a pipeline flow diverter and endonasal approach was feasible in the treatment of our patient. This is the first report to our knowledge of the use of pipeline flow diversion in the management of a cavernous carotid aneurysm prior to pituitary adenoma treatment.

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Section: Discussionmentioning

confidence: 99%

Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review

et al. 2021

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“…It has been previously reported that both the panhypopituitarism and the hyperprolactinemia can be completely resolved by resection of the mass lesion (6). Concurrent pituitary macroadenomas have also been reported to coexist with GICAA (8).…”

Section: Discussionmentioning

confidence: 99%

Concurrent Panhypopituitarism and Hyperprolactinemia Due to a Giant Internal Carotid Aneurysm Revealed by Thyroid Hormone Withdrawal During Follow-Up Management of Thyroid Cancer

Goldman

Gruber

Herman

2016

AACE Clinical Case Reports

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Objective: This article reports a case of secondary hypothyroidism occurring during the withdrawal of thyroid hormone replacement in a patient with thyroid cancer that led to the discovery of simultaneous panhypopituitarism and hyperprolactinemia that were caused by an internal carotid artery aneurysm. The discovery of the secondary hypothyroidism necessitated further pituitary hormone analysis and medical imaging to identify the precise pathologic etiology. Methods: The methods used included the evaluation of selected thyroid and pituitary hormone concentrations and subsequent pituitary magnetic resonance imaging. Results: An 86-year-old African-American female with a history of thyroid cancer exhibited a suppressed serum thyroid-stimulating hormone concentration that failed to increase during progressive lowering of her thyroxine dosage despite it causing a simultaneous subnormal free thyroxine concentration. Laboratory findings indicated secondary hypothyroidism and subsequently panhypopituitarism and hyperprolactinemia. Pituitary magnetic resonance imaging revealed the presence of a large carotid aneurysm that had invaded the sella turcica. Additional hormone analyses revealed elevated prolactin, low gonad

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“…Simultaneous microsurgical treatment of the aneurysm and pituitary adenoma through a frontotemporal [ 4 , 6 , 7 ] or supraorbital keyhole approach [ 8 ] was reported. Endovascular embolization of cerebral aneurysm followed by transsphenoidal microsurgery [ 9 – 12 ] or medical therapy [ 13 ] was also documented. In the present case, with an aim to prevent the possible risk to the patient from the proximity of the aneurysm to the operative field, the cerebral aneurysm was first treated with endovascular coil placement; subsequently, pseudocapsule-based extracapsular resection of the pituitary tumor via a transnasal transsphenoidal endoscopic approach was performed.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Extracapsular Removal of Pituitary Adenoma: The Importance of Pretreatment of an Adjacent Unruptured Internal Carotid Artery Aneurysm

Yamada

Hirohata

et al. 2012

Case Reports in Neurological Medicine

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The presence of an intracranial aneurysm together with a pituitary adenoma presents tremendous risk of subarachnoid hemorrhage, during transsphenoidal surgery, particularly when the aneurysm lies near the operative field. A left supraclinoid internal carotid artery aneurysm and a clinically nonfunctioning pituitary adenoma coexisted in a 57-year-old woman. Initially, the aneurysm was treated by endovascular coil placement, and then the patient underwent pseudocapsule-based extracapsular resection of the pituitary tumor via a transnasal transsphenoidal endoscopic approach. Pseudocapsule-based extracapsular total resection was safely performed, because of the extirpated risk of rupture of the coil-treated aneurysm. Recently, transsphenoidal pseudocapsule-based extracapsular resection approach for pituitary adenomas provides a more effective and safe alternative compared to the traditional intracapsular one because of its higher tumor removal and remission rates and lower recurrence rate. Compared with conventional subcapsular removal, pseudocapsule-based extracapsular resection has more risks of aneurysmal rupture that is located adjacent to pituitary adenoma. Thus, in a patient having a cerebral aneurysm with the proximity to the operative field, the cerebral aneurysm should be first treated with endovascular coil placement or direct surgical procedure; subsequently, pseudocapsule-based extracapsular resection of the pituitary tumor via a transnasal transsphenoidal endoscopic approach should be performed.

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Pituitary macroadenoma co-existent with supraclinoid internal carotid artery cerebral aneurysm: a case report and review of the literature

Cited by 13 publications

References 18 publications

Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review

Management of Coincident Pituitary Macroadenoma and Cavernous Carotid Aneurysm: A Systematic Literature Review

Concurrent Panhypopituitarism and Hyperprolactinemia Due to a Giant Internal Carotid Aneurysm Revealed by Thyroid Hormone Withdrawal During Follow-Up Management of Thyroid Cancer

Endoscopic Extracapsular Removal of Pituitary Adenoma: The Importance of Pretreatment of an Adjacent Unruptured Internal Carotid Artery Aneurysm

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