Pituitary

, Volume 11, Issue 3, pp 307–311 | Cite as

A case of macroprolactinoma encasing an internal carotid artery aneurysm, presenting as pituitary apoplexy

  • Anushka Soni
  • Samantha Roshani De Silva
  • Kate Allen
  • James V. Byrne
  • Simon Cudlip
  • John A. H. Wass
Case Report

Abstract

We present the first case of successful non-surgical treatment of an internal carotid aneurysm, embedded within a macroprolactinoma. A 53 year old male, with a previous history of Non-Hodgkin’s Lymphoma (NHL), presented with severe right sided frontal headache, decreased visual acuity, and ophthalmolplegia due to a third nerve palsy. A CT scan showed a 4.6 by 4.8 cm mass in the pituitary fossa with bony erosion. Initially, it was thought to be a cerebral recurrence of the Non-Hodgkin’s disease. Direst questioning revealed a long history of erectile dysfunction with loss of libido. Prolactin at presentation was 537, 200 mU/l and a diagnosis of macroprolactinoma, with apoplexy was made. A subsequent MRI brain confirmed a large macroadenoma with an intra cavernous aneurysm encased by the tumour. A therapeutic dilemma ensued due to the need for urgent decompression of the visual pathways, preferably by surgery. However, in the presence of an intrasellar aneurysm, surgery would have been extremely hazardous. The patient was therefore commenced on cabergoline and rapidly titrated up to 4 mg per week. The aneurysm was treated by endovascular occlusion of the right carotid artery under radiological control. The combination of these therapies, without conventional surgical intervention, resulted in resolution of the third nerve palsy and recovery of visual acuity in the left eye. The diagnosis and management of this condition was challenging and the final outcome, with non-surgical treatment and carotid artery occlusion was satisfactory.

Keywords

Prolactinoma Apoplexy Internal carotid aneurysm 

Notes

Acknowledgements

The authors would like to thank Dr. Olaf Ansorge for providing the histopathology slides and Dr. Nishan Guha for guidance on the biochemical techniques.

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Anushka Soni
    • 1
  • Samantha Roshani De Silva
    • 1
  • Kate Allen
    • 1
  • James V. Byrne
    • 2
  • Simon Cudlip
    • 3
  • John A. H. Wass
    • 1
  1. 1.Department of EndocrinologyThe Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill HospitalOxfordUK
  2. 2.Department of NeuroradiologyThe John Radcliffe HospitalOxfordUK
  3. 3.Department of NeurosurgeryRadcliffe InfirmaryOxfordUK

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