Case reportCoexistence of aneurysmal subarachnoid haemorrhage and pituitary apoplexy: Case report and review of the literature
Section snippets
Case report
This 51 year old, previously healthy, left handed female presented four days after sudden loss of consciousness while showering, followed by a global headache and general malaise and later vomiting. She did not report neck stiffness or photophobia, although she noted her vision, which had been poor particularly in the left eye for 2 years, was blurred. She remained independent and had improving symptoms until day 4 following the initial collapse, when she again felt generally unwell and had
Discussion
The term pituitary apoplexy has been traditionally applied to the sudden onset of symptoms (typically visual deterioration, extraocular palsies, headache or altered conscious state) associated with haemorrhage (usually haemorrhagic infarction) into, or occasionally infarction of, a pituitary adenoma.[1], [2], [3], [4] However, many reports have not distinguished between this acute clinical entity and subclinical haemorrhage into a pituitary adenoma not associated with acute presentation
Conclusion
Although the association of pituitary tumour and aneurysm might not be more frequent than chance coexistence, the diagnostic difficulties and treatment implications of this not infrequent association are such that it must be considered in all cases of parasellar lesions, particularly with acute presentation. MRI and DSA provide essential information in such cases. Craniotomy allows coexisting aneurysm and pituitary macroadenomas to be simultaneously treated.
References (40)
- et al.
Rupture of anterior communicating artery aneurysm during transsphenoidal surgery for pituitary adenoma
Surg. Neurol.
(1983) - et al.
Surgery of incidental intracranial aneurysms
Surg. Neurol.
(1987) - et al.
A retrospective analysis of pituitary apoplexy
Neurosurgery
(1993) - et al.
Pituitary apoplexy: a review
Neurosurgery
(1984) - et al.
Pituitary apoplexy: endocrine, surgical and oncological emergency. Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas
Acta Neurochir (Wien)
(1993) - et al.
Pituitary tumours
- et al.
Classical pituitary apoplexy: clinical features, management and outcome
Clin. Endocrinol. (Oxf.)
(1999) - et al.
Pituitary apoplexy: its incidence and clinical significance
J. Neurosurg.
(1981) - et al.
Bleeding intracranial aneurysm? Pituitary apoplexy!
Br. J. Clin. Pract.
(1991) - et al.
Pituitary apoplexy: a transient benign presentation mimicking mild subarachnoid hemorrhage with negative angiography
Eur. J. Neurol.
(1998)
Subarachnoid hemorrhage with normal cerebral angiography: a prospective study on sellar abnormalities and pituitary function
Neurosurgery
Pituitary apoplexy presenting as massive subarachnoid hemorrhage
J. Neurol. Neurosurg. Psychiatry
Subarachnoid haemorrhage and vasospasm due to pituitary apoplexy after pituitary function tests
Acta Neurochir (Wien)
Pituitary and parapituitary tumours on computed tomography. A review article based on 230 cases
Br. J. Radiol.
A further case of giant intrasellar carotid aneurysm mimicking a pituitary adenoma: the relevance of a multivariate approach in differential diagnosis
Ital. J. Neurol. Sci.
Aneurysm of the internal carotid artery simulating pituitary tumor with panhypopituitarism—a case report
Changgeng Yi Xue Za Zhi
Differential diagnosis of intrasellar tumors by computed tomography
Radiology
Giant aneurysms of the sellar region simulating pituitary adenomas: a diagnosis to be considered
J. Endocrinol. Invest.
Carotid artery aneurysm simulating pituitary adenoma
J. Clin. Neuroophthalmol.
Comparison of MR imaging, CT, and angiography in the evaluation of the enlarged cavernous sinus
AJR Am. J. Roentgenol.
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Clinical Features, Management Considerations and Outcomes in Case Series of Patients with Parasellar Intracranial Aneurysms Undergoing Anterior Skull Base Surgery
2017, World NeurosurgeryCitation Excerpt :A case of medical management of a prolactinoma presenting with apoplexy in a patient with an ICA IA projecting into the tumor has been reported with good outcome.41 Rupture of an embedded IA may present with the appearance of apoplexy,35,42 and concurrent IA rupture and pituitary apoplexy may also occur.43-46 There is likely an interaction between these 2 pathologies, as the delicate balance of blood supply to pituitary macroadenomas is likely to be disturbed when intracranial hemodynamics are altered in a patient with a ruptured IA.
Manifestation, management and outcome of subclinical pituitary adenoma apoplexy
2009, Journal of Clinical NeuroscienceCitation Excerpt :Three patients in our series also had an intracranial aneurysm. The relationship with pituitary apoplexy remains unclear.18,19 All 185 patients received surgical intervention, including transsphenoidal surgery in 133 patients and transcranial surgery in the remaining 52 patients.
Pituitary apoplexy associated with anterior communicating artery aneurysm and aberrant blood supply
2006, Journal of Clinical NeuroscienceAneurysmal subarachnoid haemorrhage in the pituitary fossa of a patient with acromegaly – a rare phenomenon
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