An unusual cause of hypopituitarism with An even more unusual presentation - a case report

Hypopituitarism is a rare clinical condition which can present as partial or complete absence of pituitary hormones. The most common cause is a sellar or parasellar mass, particularly tumour, and the golden standard for differential diagnosis is magnetic resonance imaging. Intrasellar aneurysm is an unusual cause of hypopituitarism with an estimated incidence of 0,17% of cases. Case presentation We report a case of a 72-year-old male who was admitted to the hospital due to symptoms of gastrointestinal disorder accompanied by malnourishment. Due to persistent hyponatremia and spontaneous hypoglycaemia in laboratory findings, the examination of hypothalamic-pituitary-adrenal axis was eventually initiated, and the patient was later diagnosed with unruptured aneurysm of the ophthalmic segment of the right internal carotid artery with extension into the sella, as a cause of panhypopituitarism. A combined endovascular treatment was performed with stent assisted coil embolization of the aneurysm and the patient was prescribed with oral hormone therapy. At the 1-year follow-up visit, pituitary MRI showed complete aneurysm occlusion and partial ’empty’ sella with significantly decreased volume of the hypophysis, and no improvement in the pituitary function has been observed. Conclusions Aneurysms of the internal carotid artery are a rare, but potential cause of hypopituitarism with a possible delay in diagnosis due to unusual clinical presentation. Endovascular procedure such as coil embolization of the aneurysm could be the treatment of choice in these patients. Persistent hypopituitarism could be expected even after a successful treatment of the aneurysm.