Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature
Background/Objective: A thrombosed internal carotid artery (ICA) aneurysm mimicking a pituitary adenoma can be catastrophic if unrecognized. We report a unique case of the rare presentation of ICA aneurysms masquerading as pituitary adenomas, which can preserve pituitary function when treated early....
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | AACE Clinical Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060523000056 |
| _version_ | 1797860257623441408 |
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| author | Hiba Z. Hashmi, MD Sindhura Inkollu, MD Deeptanshu Jain, MD Ramachandra Tummala, MD Takako Araki, MD Tasma Harindhanavudhi, MD, MS |
| author_facet | Hiba Z. Hashmi, MD Sindhura Inkollu, MD Deeptanshu Jain, MD Ramachandra Tummala, MD Takako Araki, MD Tasma Harindhanavudhi, MD, MS |
| author_sort | Hiba Z. Hashmi, MD |
| collection | DOAJ |
| description | Background/Objective: A thrombosed internal carotid artery (ICA) aneurysm mimicking a pituitary adenoma can be catastrophic if unrecognized. We report a unique case of the rare presentation of ICA aneurysms masquerading as pituitary adenomas, which can preserve pituitary function when treated early. Case Report: A 54-year-old man with type 2 diabetes, aortic valve replacement, and stroke presented with sudden onset severe headache and left eye pain. Left third nerve palsy was noted. Laboratory studies showed low thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, testosterone, and insulin-like growth factor 1 levels and baseline, post–30-minute, and post–60-minute cortisol levels of 16, 17, and 14 μg/dL, respectively, after adrenocorticotropic hormone stimulation. Magnetic resonance imaging of the pituitary revealed a heterogeneously enhancing 2.0 × 2.1 × 2.1-cm sellar/suprasellar mass with peripheral enhancement abutting the left cavernous sinus. Given the acute third nerve palsy without visual defects and magnetic resonance imaging findings, other sources of sellar occupying etiology were suspected. Therefore, carotid cerebral angiography was performed and revealed a mostly thrombosed left ICA aneurysm projected into the sellar/suprasellar region. The patient underwent successful endovascular treatment with a resolution of the cranial nerve palsy and hormonal abnormalities at 3-month follow-up. Discussion: Our case demonstrates the importance of swift recognition of ICA aneurysms masquerading as pituitary adenomas. Early recognition and treatment may lead to the complete resolution of presenting symptoms and hormonal deficiencies. Conclusion: Clinicians should have a high index of suspicion for ICA aneurysm in the differential diagnosis for a sellar mass. Careful evaluation is essential because misdiagnosis may lead to catastrophic consequences. |
| first_indexed | 2024-04-09T21:42:22Z |
| format | Article |
| id | doaj.art-f3c4261b50fd4c9c974c39f6e915ffec |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-04-09T21:42:22Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-f3c4261b50fd4c9c974c39f6e915ffec2023-03-26T05:17:19ZengElsevierAACE Clinical Case Reports2376-06052023-03-01923943Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the LiteratureHiba Z. Hashmi, MD0Sindhura Inkollu, MD1Deeptanshu Jain, MD2Ramachandra Tummala, MD3Takako Araki, MD4Tasma Harindhanavudhi, MD, MS5Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MinnesotaDivision of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MinnesotaRochester General Hospital, Rochester, New YorkDepartment of Neurosurgery, University of Minnesota, Minneapolis, MinnesotaDivision of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MinnesotaDivision of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Address correspondence to Dr Tasma Harindhanavudhi, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 101, Minneapolis, MN 55455.Background/Objective: A thrombosed internal carotid artery (ICA) aneurysm mimicking a pituitary adenoma can be catastrophic if unrecognized. We report a unique case of the rare presentation of ICA aneurysms masquerading as pituitary adenomas, which can preserve pituitary function when treated early. Case Report: A 54-year-old man with type 2 diabetes, aortic valve replacement, and stroke presented with sudden onset severe headache and left eye pain. Left third nerve palsy was noted. Laboratory studies showed low thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, testosterone, and insulin-like growth factor 1 levels and baseline, post–30-minute, and post–60-minute cortisol levels of 16, 17, and 14 μg/dL, respectively, after adrenocorticotropic hormone stimulation. Magnetic resonance imaging of the pituitary revealed a heterogeneously enhancing 2.0 × 2.1 × 2.1-cm sellar/suprasellar mass with peripheral enhancement abutting the left cavernous sinus. Given the acute third nerve palsy without visual defects and magnetic resonance imaging findings, other sources of sellar occupying etiology were suspected. Therefore, carotid cerebral angiography was performed and revealed a mostly thrombosed left ICA aneurysm projected into the sellar/suprasellar region. The patient underwent successful endovascular treatment with a resolution of the cranial nerve palsy and hormonal abnormalities at 3-month follow-up. Discussion: Our case demonstrates the importance of swift recognition of ICA aneurysms masquerading as pituitary adenomas. Early recognition and treatment may lead to the complete resolution of presenting symptoms and hormonal deficiencies. Conclusion: Clinicians should have a high index of suspicion for ICA aneurysm in the differential diagnosis for a sellar mass. Careful evaluation is essential because misdiagnosis may lead to catastrophic consequences.http://www.sciencedirect.com/science/article/pii/S2376060523000056Hypopituitarisminternal carotid artery aneurysmpituitary adenoma |
| spellingShingle | Hiba Z. Hashmi, MD Sindhura Inkollu, MD Deeptanshu Jain, MD Ramachandra Tummala, MD Takako Araki, MD Tasma Harindhanavudhi, MD, MS Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature AACE Clinical Case Reports Hypopituitarism internal carotid artery aneurysm pituitary adenoma |
| title | Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature |
| title_full | Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature |
| title_fullStr | Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature |
| title_full_unstemmed | Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature |
| title_short | Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature |
| title_sort | internal carotid artery aneurysm mimicking a pituitary adenoma a case report and review of the literature |
| topic | Hypopituitarism internal carotid artery aneurysm pituitary adenoma |
| url | http://www.sciencedirect.com/science/article/pii/S2376060523000056 |
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