Aneurysm of the internal carotid artery simulating pituitary tumor with panhypopituitarism--a case report

A 59-year-old female patient presented with conscious disturbance and hyponatremia. Baseline endocrine studies revealed secondary hypothyroidism and hypoadrenalism. Further studies of skull X-ray, brain CT scan, dynamic endocrine tests and visual field examination favored pituitary tumor with panhypopitutarism. Trans-sphenoid surgical intervention was arranged. However the management was changed because the preoperative carotid angiography revealed the mass lesion over the cavernous sinus region was an aneurysm, not a pituitary tumor. The patient refused surgical intervention for the aneurysm and received thyroxine and cortisone replacement until the present time. Because the surgical treatment of an aneurysm is different from a pituitary tumor, we reported this case to emphasize the importance of routine carotid angiography in the evaluation of the sellar mass.