Endocrine Abstracts

Rationale and aim: The incidence of intracranial aneurysms (IA) appears increased in patients with PAs/PitNETs. Changes in hemodynamics and vascular structure secondary to mass effect, inflammation, and hormonal changes (primarily, GH hypersecretion) have been suggested as risk factors. Study aim was to define typical features, timing of occurrence and treatment, and identify risk factors in patients with PA/PitNET and IA.

Patients and methods: Data of 57 cases (20 males) of IA associated with PA/PitNET, identified by screening 5,146 patients with PA/PitNET and 25,104 with IA evaluated at two referral Centers from 1998 to 2022, were retrospectively reviewed.

Results: Mean age at diagnosis was 52.6 ± 12 (range 28-84) years for PA/PitNET, 57.4 ± 11.6 (30-83) for IA. Forty-one (77.4%; 18 males) had a macroadenoma, 32 (82%) with extrasellar extension, and 24 (61.5%) with cavernous sinus invasion. IA was diagnosed after PA/PitNET in 30 (52.6%) cases, simultaneously in 17 (29.9%), before in 10 (17.5%). 50 (87.7%) PAs/PitNETs were treated by transsphenoidal surgery, 6 (10.5%) by craniotomy. Based on histology, 29.6% were lactotroph, 11.1% corticotroph, 18.5 somatotroph, 14.8% somato-lactotroph, 14.8% gonadotroph, and 11.1% plurihormonal. Six patients (10.5%) presented multiple IAs. Mean IA size was 4.8 ±3.9 (range 1-26) mm. Typical localizations were internal carotid artery (47.4%), anterior carotid artery (19.3%), and middle cerebral artery (14%); 56.1% of IA originated in proximity of the sella turcica. Treatment consisted of endovascular embolization in 17 (29.8%) patients, surgery in 4 (7.1%), clipping in 1 (1.8%), multiple treatments in 3 (5.3); 31 (55.4%) were not treated. Regarding risk factors, 20 (35.1%) patients had familiarity of aneurysm, none of pituitary adenoma; 2 (3.5%) had connective disorders; 18 (32.1%) had previously undergone sellar surgery and 8 (14%) radiotherapy. 54/57 (94.7%) patients presented ≥1 cardiovascular risk factor (i.e., smoking 47.4%, hypertension 70.2%, dyslipidemia 36.8%, diabetes 28.1%, overweight/obesity 71.7%, stroke/infarction 24.6%, other cardiovascular diseases 12.8%), 46 (80.7%) ≥2 risk factors.

Conclusions: Our study supports the need of screening for AI in patients with invasive macroadenomas, especially with previously surgery/radiotherapy, cardiovascular risk factors and GH hypersecretion.