Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Department of Endocrinology, Diabetes and Metabolism, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
BMJ Case Rep. 2024 Apr 19;17(4):e258533. doi: 10.1136/bcr-2023-258533.
We present a fatal complication of treatment in a patient with early-onset acromegaly, treated with two transsphenoidal operations, radiotherapy, radiosurgery and pegvisomant. He was diagnosed in his 30s, and controlled from his 40s, with stable residual tumour within the left cavernous sinus. In his 60s, 30 years after surgery/radiotherapy and 14 years after radiosurgery, he developed recurrent episodes of mild epistaxis. A week later, he presented at his local hospital's emergency department with severe epistaxis and altered consciousness. He was diagnosed with a ruptured internal carotid artery (ICA) pseudoaneurysm, but unfortunately died before treatment could be attempted.ICA pseudoaneurysms are rare complications of surgery or radiotherapy and can present with several years of delay, often with epistaxis. This case highlights the importance of life-long monitoring in patients with previous pituitary interventions and early recognition of epistaxis as a herald sign of a potentially catastrophic event, thus leading to timely treatment.
我们报告了一位早发型肢端肥大症患者在接受经蝶窦手术、放疗、伽玛刀治疗和培维索孟治疗后的致命并发症。该患者在 30 多岁时被诊断出患有肢端肥大症，并在 40 多岁时得到控制，其左侧海绵窦内残留肿瘤稳定。在接受手术/放疗 30 年后和伽玛刀治疗 14 年后，他在 60 多岁时出现反复发作的轻度鼻出血。一周后，他因严重鼻出血和意识改变到当地医院急诊科就诊。他被诊断为颈内动脉（ICA）假性动脉瘤破裂，但不幸的是，在尝试治疗之前死亡。ICA 假性动脉瘤是手术或放疗的罕见并发症，可在数年后出现，常以鼻出血为首发症状。该病例强调了对有垂体介入治疗史的患者进行终身监测的重要性，以及早期识别鼻出血作为潜在灾难性事件的先兆迹象的重要性，从而及时进行治疗。
