Unruptured Giant Internal Carotid Artery Aneurysm Compressing the Pituitary Gland Leading to Panhypopituitarism

Authors

Sapna Sharma, Division of Endocrinology, Diabetes and Metabolism, Reading Hospital - Tower Health, West Reading, PAFollow
Madhav Acharya, Division of Endocrinology, Diabetes and Metabolism, Reading Hospital - Tower Health, West Reading, PAFollow
Sara Bean, Division of Neurosurgery, Reading Hospital - Tower Health, West Reading, PAFollow
Shahin Manoochehri, Division of Neurosurgery, Reading Hospital - Tower Health, West Reading, PAFollow
Vinita Singh, Division of Endocrinology, Diabetes and Metabolism, Reading Hospital - Tower Health, West Reading, PAFollow

Document Type

Article

Publication Date

10-1-2025

Abstract

Background/Objective: Internal carotid artery aneurysms are rare and can lead to hypopituitarism due to their mass effect. Hypopituitarism triggered by aneurysmal compression may persist, and postsurgical restoration of pituitary function is challenging, often necessitating long-term hormone replacement therapy. We herein report a case of hypopituitarism caused by intrasellar aneurysm. Case Report: A 77-year-old female with history of left eye blindness, Hashimoto's thyroiditis, and chronic kidney disease presented with nausea, vomiting, malaise, and altered mental status. Physical examination was unremarkable with no visual field or neurologic deficits except for blindness in left eye. The patient was noted to have hyponatremia which prompted checking serum cortisol level and endocrinology consultation. Workup demonstrated secondary adrenal insufficiency with low cortisol and low adrenocorticotropic hormone, central hypogonadism, and secondary hypothyroidism with low serum thyroid-stimulating hormone and low free thyroxine level. Prolactin was mildly elevated, likely due to stalk effect. Imaging revealed 2.3 × 3.1 × 2.3 cm right cavernous carotid aneurysm in the sella extending into the suprasellar cistern. Hydrocortisone therapy was started, and levothyroxine dose was adjusted which improved her mental status. Subsequently, the patient underwent stent-assisted coil embolization after unsuccessful placement of a flow diversion device by neurosurgery. The patient continues to be on hormone replacement therapy. Discussion/Conclusion: Close monitoring of pituitary hormones is required in the context of giant intrasellar aneurysms, given their potential to induce pituitary dysfunction through mass effect. Timely diagnosis and intervention are paramount to prevent fatal outcomes.

Publication Title

AACE Endocrinology and Diabetes

Comments

[Article in Press]

Recommended Citation

Sharma, S., Acharya, M., Bean, S., Manoochehri, S., & Singh, V. (2025). Unruptured Giant Internal Carotid Artery Aneurysm Compressing the Pituitary Gland Leading to Panhypopituitarism. AACE Endocrinology and Diabetes https://doi.org/https://doi.org/10.1016/j.aed.2025.09.018