Transient Aggravation of Hypopituitarism After Parent Artery Occlusion with Low-Flow Bypass for Unruptured Giant Cavernous Carotid Aneurysm.

Abstract

Hypopituitarism is not well known after the treatment of a cavernous carotid aneurysm extending to the sellar region by the parent artery occlusion and bypass surgery. A 60-year-old female presented with a 2-year-old progressive visual disturbance. The patient had no pituitary hormone-related symptoms or signs, but elevated prolactin and decreased free thyroxin levels are shown on blood examination. Neuroimages revealed a right giant partially thrombosed cavernous carotid aneurysm compressing the sella turcica markedly. The aneurysm was treated by the right cervical internal carotid artery ligation with the right superficial temporal artery-middle cerebral artery double anastomoses. The patient had headache, general fatigue, chilling, and hypoactivity on postoperative day 6, when aneurysmal mass effects were transiently increased on neuroimages, associated with hypocortisolism and hyponatremia. Hydrocortisone administration improved the symptoms and was tapered off at 8 months post surgery, as the aneurysm shrank and pituitary hormone values were normalized except for prolactin. Hypopituitarism should be taken into consideration even after the parent artery occlusion with bypass surgery for a giant carotid aneurysm compressing the sella turcica.