A case of macroprolactinoma associated with a giant carotid artery aneurysm
S Sihota1, M Porte2 & J Thow1
We report a 56-year-old male patient who presented in September 2006 with a left eye inferior temporal visual field defect and a left relative afferent pupillary defect. Imaging demonstrated a 4 cm giant cavernous left carotid aneurysm causing pressure symptoms resulting in the above visual failure.
The patient had internal carotid coil embolisation of the left internal carotid artery.
The patient re-presented in February 2008 with erectile dysfunction. Prolactin was 147 518 mU/l, testosterone 6.97 nmol/l, LH 3.6 U/l, FSH 3.1 U/l. Dynamic pituitary testing revealed a suboptimal growth hormone response; otherwise anterior pituitary function tests were normal.
Repeat MRI demonstrated a large 4.3 cm pituitary adenoma enclosing the residue of the thrombosed left internal carotid aneurysm. It is possible that the enlarging macroprolactinoma was responsible for the development of the aneurysm.
The patient was commenced on testosterone replacement, and cabergoline therapy. Thus far his prolactin has reduced to 43 450 mU/l.
This unusual case, with the accompanying images, demonstrates a macroprolactinoma extending to and enclosing the cavernous left internal carotid artery and possibly resulting in its aneurysmal dilatation.