Hypopituitarism secondary to unruptured intracavernous carotid aneurysm with sellar extension associated with ipsilateral brain abscess: a case report

Abstract

Introduction: The prevalence of intracranial aneurysms ranges from 0.4% to 3.6% in autopsy studies and from 3.7% to 6.0% in studies of patients undergoing cerebral angiography. Aneurysm projected into the sellar region account for 1% to 2% of all intracranial aneurysms and the hypopituitarism caused by them are very rare (0.17% cases). Clinical case: A 73-years-old woman was admitted in the department of ophthalmology with headache, fever, painful proptosis of the right eye and visual loss. Her physical examination revealed nonpulsatile exophthalmos of the right eye with conjunctival hyperemia, complete loss of light perception and third nerve palsy. A head computed tomography showed a right-sided heterogeneous intracavernous mass extending to the sella. The patient's condition deteriorated due to hypotension accompanied by episodes of atrial fibrillation. She became comatose and was intubated emergently. Her hormonal investigations revealed hypopituitarism manifested of low serum free thyroxine and TSH, low ACTH and diminished basal cortisol. Multiple sets of blood cultures confirmed Gram-negative bacteremia diagnosis. She was placed on hormonal replacement therapy and empirical antibiotherapy. The digital subtraction angiogram showed an unruptured intracavernous aneurysm (15 x 17 x 11 mm) of right internal carotid artery (ICA) with sellar extension. A repeat CT scan and MRI, discovered a brain abscess in the right temporal lobe (9 x 6 mm) with perifocal edema. Antibiotics were administered intravenously during the hospitalisation (3 weeks) followed by a course of oral antimicrobial therapy (3 weeks) adapted to culture results. After 24 days of hospitalization, the patient status improved and she was discharged home with treatment recommendations.Conclusion: To the best of the authors' knowledge, this represents the first reported case in the literature of hypopituitarism secondary to unruptured intracavernous carotid aneurysm with sellar extension Associated with ipsilateral brain abscess.