Qi Meng, Ye Ming, Li Meng, Zhang Peng
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Department of Interventional Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Open Med (Wars). 2018 Apr 18;13:137-141. doi: 10.1515/med-2018-0021. eCollection 2018.
Internal carotid artery (ICA) supraclinoid segment aneurysms extending into the sellar region and leading to pituitary dysfunction are a rare occurrence. To date, long-term follow up of pituitary function 2 years post-treatment has never been reported. Herein, we present a case of pituitary dysfunction due to an unruptured ophthalmic segment internal carotid artery aneurysm and report improved 2-year follow-up results. A 76-year-old male presented with disturbed consciousness due to hyponatremia, which was caused by hypoadrenocorticism resulting from pituitary dysfunction complicated by hypogonadism and hypothyroidism. Computed tomography angiography revealed an intracranial aneurysm of the ophthalmic segment of the right ICA with an intrasellar extension. Thus, digital subtraction angiography and coil embolization were performed, followed by hormone replacement therapy. A 2-year follow-up revealed a partial improvement in the pituitary function, including complete restoration of thyroid-stimulating hormone level and other thyroid hormones levels, and partial restoration of testosterone levels, followed by discontinuation of thyroid hormone replacement therapy. However, the mechanisms of such pituitary dysfunction and the effects of various treatments, including clipping and coiling, on different hormones of pituitary function recovery remain unclear. A long-term follow-up of >2 years may elucidate the pituitary function recovery post-treatment and provide a medication adjustment for hormone replacement therapy.
颈内动脉（ICA）床突上段动脉瘤延伸至鞍区并导致垂体功能障碍的情况较为罕见。迄今为止，尚未有关于治疗后2年垂体功能长期随访的报道。在此，我们报告一例因未破裂的眼段颈内动脉动脉瘤导致垂体功能障碍的病例，并报告2年随访的改善结果。一名76岁男性因低钠血症出现意识障碍，低钠血症由垂体功能障碍并发性腺功能减退和甲状腺功能减退导致的肾上腺皮质功能减退引起。计算机断层血管造影显示右侧ICA眼段颅内动脉瘤并向鞍内延伸。因此，进行了数字减影血管造影和弹簧圈栓塞治疗，随后进行了激素替代治疗。2年随访显示垂体功能有部分改善，包括促甲状腺激素水平及其他甲状腺激素水平完全恢复，睾酮水平部分恢复，随后停用了甲状腺激素替代治疗。然而，这种垂体功能障碍的机制以及包括夹闭和弹簧圈栓塞在内的各种治疗对垂体功能恢复的不同激素的影响仍不清楚。超过2年的长期随访可能会阐明治疗后垂体功能的恢复情况，并为激素替代治疗提供药物调整依据。
