title: Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma.
abstract: Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients.
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Zesheng
authors.initials: Z
authors.lastname: Peng
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Daofeng
authors.initials: D
authors.lastname: Tian
authors.affiliation: Department of Neurosurgery, The Second People's Hospital of Jingzhou City Jingzhou, Hubei Province, China.
authors.forename: Hongliu
authors.initials: H
authors.lastname: Wang
authors.affiliation: School of Medicine, Yale University New Haven, CT, 06511.
authors.forename: Derek Kai
authors.initials: DK
authors.lastname: Kong
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Shenqi
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Baohui
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Deng
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Liquan
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Baowei
authors.initials: B
authors.lastname: Ji
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Long
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Cai
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Mingchang
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Junmin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Aimin
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Renmin Hospital of Wuhan University Wuhan, Hubei Province, China.
authors.forename: Qianxue
authors.initials: Q
authors.lastname: Chen
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion; D001971:Bromocriptine / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D004844:Epistaxis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006727:Hormone Antagonists / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015175:Prolactinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016634:Radiosurgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D006727:Hormone Antagonists; D001971:Bromocriptine
keywords: Cerebral aneurysm; epistaxis; pituitary adenoma; pituitary apoplexy
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