Endocrine Abstracts

Aneurysmal subarachnoid hemorrhage has been reported to be associated with hypopituitarism. Also, internal carotid artery coil embolisation for aneurysmal hemorrhage is a rare cause of hypopituitarism. 58-year-old female patient who admitted to Emergency Department of Gazi University Medical Faculty due to visual loss and severe headache that did not respond to analgesics accompanied by nausea-vomiting starting 4–5 days ago. Sixth cranial nerve paralysis and bilateral temporal hemianopsia were detected in the neurological examination. In the Cranial computerised tomography (CT), there were widespread subarachnoid hemorrhages. In the Cranial CT Angiography, an aneurysm (29×18×18 mm) involving the cavernous segment of the right internal carotid artery (ICA) was observed. For this reason, selective cerebral angiography was performed. Coiling embolisation was performed for the aneurysm. Later, the complaints of mouth dryness, polyuria, polydipsia, and fatigue were developed in 2–3 days after subrachnoid hemorrhage and coil embolisation. The laboratory analysis showed that Na: 149 (136–145) meq/l, urinary density: 1008 (1010–1020), IGF-1: 78.5 (81–225) ng/ml, GH: 0.36 (0.01–8) ng/ml, ACTH: 19.6 (0–46) pg/ml, Cortisol 1.52 (4.6–22.8) μg/dl, FSH: 5.53 (23.9–119.1) mIU/l, LH: 0.36 (16.3–54.8) mIU/l, E₂: 11 pg/ml (10–28), prolactin: 0 (2.4–20.9) ng/ml, TSH 0.47 (0.57–5.6) μgIU/ml, free T₃: 1.3 (2.3–4.2) pg/ml and free T₄: 0.9 (0.74–1.52) ng/dl. In the cranial MRI after the procedure, aneurysm lumen was filled with coils and its mass effect caused substantial displacement of the hypophysis gland to the left side. Clinical features, laboratory findings and imaging suggested panhypopituitarism associated with aneurysmal hemorrhage of internal carotid artery as well as procedure of coil embolisation. Corticosteroid, vasopressin and levothyroxine replacement treatment were started. After the hormonal replacement therapy, general condition of the patient and vision improved, nausea and vomiting stopped and urine output decreased. In conlusion, we presented a rare case who had panhypopituitarism including diabetes insipidus developed in 2–3 days after aneurysmal hemorrhage of internal carotid artery and coil embolisation of carotid artery aneursym. This rare cause of pituitary dysfunction should be kept in mind in the clinical setting.