Diagnosis and treatment of pituitary adenoma with adjacent carotid artery aneurysm

We present three cases of pituitary adenoma with adjacent carotid artery aneurysm. The three adenomas are HGH-producing, prolactinoma and non-functioning tumors. Two of these 3 patients showed signs and symptoms of adenoma, while the other one showed a subarachnoid hemorrhage (SAH). The presence of the aneurysm adjacent to the pituitary adenoma was strongly suspected by the MRI finding, and the flow void signal sign just attached to the carotid artery in acromegalic patient. In a case of recurrent pituitary adenoma, development of the aneurysm was observed at a 17 year interval between angiography. Although the etiology of these lesion is not yet known, the change of hemodynamism seemed to have a major role in producing the aneurysm in all cases. The simultaneous treatment of the pituitary adenoma with aneurysm produced good results in all patients by the frontotemporal approach. MRI proved to be quite a useful tool in the management of cases of pituitary adenoma with adjacent carotid artery aneurysm. Cerebral angiography should also be performed without hesitation in such cases in which the MRI shows a significant finding of aneurysm. Simultaneous treatment of these lesions by a frontotemporal approach is recommended.