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Ruptured aneurysm–induced pituitary apoplexy: illustrative case

BACKGROUND: Pituitary apoplexy associated with aneurysmal rupture is extremely rare and may be misdiagnosed as primary pituitary adenoma apoplexy. The authors present a case of a patient with pituitary apoplexy caused by rupture of an anterior cerebral artery aneurysm embedded within a giant pituita...

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Autores principales: Yoshida, Michiharu, Hiu, Takeshi, Baba, Shiro, Morikawa, Minoru, Horie, Nobutaka, Ujifuku, Kenta, Yoshida, Koichi, Matsunaga, Yuki, Niino, Daisuke, Xie, Ang, Izumo, Tsuyoshi, Anda, Takeo, Matsuo, Takayuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245750/
https://www.ncbi.nlm.nih.gov/pubmed/35854902
http://dx.doi.org/10.3171/CASE21169
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author Yoshida, Michiharu
Hiu, Takeshi
Baba, Shiro
Morikawa, Minoru
Horie, Nobutaka
Ujifuku, Kenta
Yoshida, Koichi
Matsunaga, Yuki
Niino, Daisuke
Xie, Ang
Izumo, Tsuyoshi
Anda, Takeo
Matsuo, Takayuki
author_facet Yoshida, Michiharu
Hiu, Takeshi
Baba, Shiro
Morikawa, Minoru
Horie, Nobutaka
Ujifuku, Kenta
Yoshida, Koichi
Matsunaga, Yuki
Niino, Daisuke
Xie, Ang
Izumo, Tsuyoshi
Anda, Takeo
Matsuo, Takayuki
author_sort Yoshida, Michiharu
collection PubMed
description BACKGROUND: Pituitary apoplexy associated with aneurysmal rupture is extremely rare and may be misdiagnosed as primary pituitary adenoma apoplexy. The authors present a case of a patient with pituitary apoplexy caused by rupture of an anterior cerebral artery aneurysm embedded within a giant pituitary adenoma, and they review the relevant literature. OBSERVATIONS: A 78-year-old man experienced sudden headache with progressive vision loss. Magnetic resonance imaging (MRI) revealed a giant pituitary tumor with abnormal signal intensity. Magnetic resonance angiography immediately before surgery showed a right A1 segment aneurysm, suggesting coexisting pituitary apoplexy and ruptured aneurysm. The patient underwent urgent transsphenoidal surgery for pituitary apoplexy. The tumor was partially removed, but the perianeurysmal component was left behind. Subsequent cerebral angiography showed a 5-mm right A1 aneurysm with a bleb that was successfully embolized with coils. Retrospective review of preoperative dynamic MRI showed extravasation of contrast medium from the ruptured aneurysm into the pituitary adenoma. Histopathologic examination showed gonadotroph adenoma with hemorrhagic necrosis. Postoperatively, the patient’s visual function improved. LESSONS: MRI identification of pituitary apoplexy caused by aneurysmal rupture has not been reported previously. Aneurysmal rupture should be considered in the differential diagnosis of pituitary apoplexy. When a ruptured aneurysm is encountered, the authors recommend treating it before addressing pituitary apoplexy.
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spelling pubmed-92457502022-07-18 Ruptured aneurysm–induced pituitary apoplexy: illustrative case Yoshida, Michiharu Hiu, Takeshi Baba, Shiro Morikawa, Minoru Horie, Nobutaka Ujifuku, Kenta Yoshida, Koichi Matsunaga, Yuki Niino, Daisuke Xie, Ang Izumo, Tsuyoshi Anda, Takeo Matsuo, Takayuki J Neurosurg Case Lessons Case Report BACKGROUND: Pituitary apoplexy associated with aneurysmal rupture is extremely rare and may be misdiagnosed as primary pituitary adenoma apoplexy. The authors present a case of a patient with pituitary apoplexy caused by rupture of an anterior cerebral artery aneurysm embedded within a giant pituitary adenoma, and they review the relevant literature. OBSERVATIONS: A 78-year-old man experienced sudden headache with progressive vision loss. Magnetic resonance imaging (MRI) revealed a giant pituitary tumor with abnormal signal intensity. Magnetic resonance angiography immediately before surgery showed a right A1 segment aneurysm, suggesting coexisting pituitary apoplexy and ruptured aneurysm. The patient underwent urgent transsphenoidal surgery for pituitary apoplexy. The tumor was partially removed, but the perianeurysmal component was left behind. Subsequent cerebral angiography showed a 5-mm right A1 aneurysm with a bleb that was successfully embolized with coils. Retrospective review of preoperative dynamic MRI showed extravasation of contrast medium from the ruptured aneurysm into the pituitary adenoma. Histopathologic examination showed gonadotroph adenoma with hemorrhagic necrosis. Postoperatively, the patient’s visual function improved. LESSONS: MRI identification of pituitary apoplexy caused by aneurysmal rupture has not been reported previously. Aneurysmal rupture should be considered in the differential diagnosis of pituitary apoplexy. When a ruptured aneurysm is encountered, the authors recommend treating it before addressing pituitary apoplexy. American Association of Neurological Surgeons 2021-06-28 /pmc/articles/PMC9245750/ /pubmed/35854902 http://dx.doi.org/10.3171/CASE21169 Text en © 2021 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Report
Yoshida, Michiharu
Hiu, Takeshi
Baba, Shiro
Morikawa, Minoru
Horie, Nobutaka
Ujifuku, Kenta
Yoshida, Koichi
Matsunaga, Yuki
Niino, Daisuke
Xie, Ang
Izumo, Tsuyoshi
Anda, Takeo
Matsuo, Takayuki
Ruptured aneurysm–induced pituitary apoplexy: illustrative case
title Ruptured aneurysm–induced pituitary apoplexy: illustrative case
title_full Ruptured aneurysm–induced pituitary apoplexy: illustrative case
title_fullStr Ruptured aneurysm–induced pituitary apoplexy: illustrative case
title_full_unstemmed Ruptured aneurysm–induced pituitary apoplexy: illustrative case
title_short Ruptured aneurysm–induced pituitary apoplexy: illustrative case
title_sort ruptured aneurysm–induced pituitary apoplexy: illustrative case
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245750/
https://www.ncbi.nlm.nih.gov/pubmed/35854902
http://dx.doi.org/10.3171/CASE21169
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