Answer for BIR CoW 02 Nov 2025
Pituitary adenoma with intratumoral aneurysm
FINDINGS
•CT cerebral angiogram reveals a relatively well defined heterodense predominantly hyperdense lesion noted involving the sellar region with suprasellar extension causing widening of sella and bony remodelling.
•The lesion shows heterogenous enhancement.
•The lesion causes complete encasement of cavernous and clinoid segment of bilateral Internal carotid artery.
•A saccular contrast filled outpouching noted arising from the cavernous segment of right ICA with fundus of aneurysm facing inferomedially.
•The aneurysm is completely encased by the above mentioned lesion.
FOLLOW UP - HORMONAL ASSAY
Prolactin - 470 ng/ml
Growth hormone - 0.22 ng/ml
LH - 0.1 mIU/ml
FSH - 0.6 mIU/ml
Increase in prolactin levels with decrease in GH,LH,FSH levels show features consistent with pituitary macroadenoma (prolactinoma) causing stalk effect.
FINDINGS
•CT cerebral angiogram reveals a relatively well defined heterodense predominantly hyperdense lesion noted involving the sellar region with suprasellar extension causing widening of sella and bony remodelling.
•The lesion shows heterogenous enhancement.
•The lesion causes complete encasement of cavernous and clinoid segment of bilateral Internal carotid artery.
•A saccular contrast filled outpouching noted arising from the cavernous segment of right ICA with fundus of aneurysm facing inferomedially.
•The aneurysm is completely encased by the above mentioned lesion.
FOLLOW UP - HORMONAL ASSAY
Prolactin - 470 ng/ml
Growth hormone - 0.22 ng/ml
LH - 0.1 mIU/ml
FSH - 0.6 mIU/ml
Increase in prolactin levels with decrease in GH,LH,FSH levels show features consistent with pituitary macroadenoma (prolactinoma) causing stalk effect.
DISCUSSION
•Various etiologies like mechanical, hormonal, microcirculatory, genetic and environmental factors are described.
•Aneursyms can be asymptomatic or mimic pituitary tumor symptoms (headache,diplopia,cranial nerve palsy).
•Risk of subarachnoid hemorrhage and pituitary apoplexy are present.
•Always rule out vascular abnormalities before trans-sphenoidal surgery.
•Multidisciplinary approach is preferred (Treat the aneurysm first followed by staged surgical removal of tumor)
REFERENCES
•Bulsara KR, Karavadia SS, Powers CJ, et al. Association between pituitary adenomas and intracranial aneurysms: an illustrative case and review of the literature. Neurol India 2007.
• Hu J, Lin Z, Zhang Y, et al. Prevalence of unruptured intracranial aneurysms coexisting with pituitary adenomas. World Neurosurg 2019.
•Various etiologies like mechanical, hormonal, microcirculatory, genetic and environmental factors are described.
•Aneursyms can be asymptomatic or mimic pituitary tumor symptoms (headache,diplopia,cranial nerve palsy).
•Risk of subarachnoid hemorrhage and pituitary apoplexy are present.
•Always rule out vascular abnormalities before trans-sphenoidal surgery.
•Multidisciplinary approach is preferred (Treat the aneurysm first followed by staged surgical removal of tumor)
REFERENCES
•Bulsara KR, Karavadia SS, Powers CJ, et al. Association between pituitary adenomas and intracranial aneurysms: an illustrative case and review of the literature. Neurol India 2007.
• Hu J, Lin Z, Zhang Y, et al. Prevalence of unruptured intracranial aneurysms coexisting with pituitary adenomas. World Neurosurg 2019.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!