Bilateral internal carotid artery aneurysm simulating pituitary apoplexy: case report

Intracavernous internal carotid artery (ICA) aneurysms can extend into the sella and simulate pituitary adenomas. However, they are rarely associated with pituitary apoplexy. We present a rare case of bilateral intracavernous ICA aneurysms simulating a sellar mass with the clinical picture of a pituitary apoplexy.

An 82-year-old woman presented with a classic case of pituitary apoplexy with a history of headache, nausea, vomiting, and diplopia. She was found to have an intrasellar mass simulating a large and invasive pituitary adenoma. The patient had a medical history positive for breast cancer.

Because of the presentation with apoplexy and the possibility of metastatic breast cancer or pituitary adenoma, the patient was explored transsphenoidally to obtain pathological verification and possibly resect the tumor. Unusual intraoperative findings led to a microDoppler evaluation, suggesting a vascular lesion. Intraoperatively, an angiogram confirmed the presence of bilateral ICA giant aneurysms involving the ICA intracavernous component extending into the sella turcica. The patient refused further treatment.

The present case indicates that an intrasellar ICA aneurysm can be misdiagnosed as a macroadenoma and even present through pituitary apoplexy. When treating intrasellar masses with the slightest suspicion of a nonpituitary origin, further workup should be considered. The possibility of a vascular lesion simulating a pituitary adenoma should always be considered by neurosurgeons and ear, nose, and throat surgeons operating in the sellar region.