伴有巨大內頸動脈瘤之腦下垂體功能低下及高泌乳素血症－一病例報告

Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Aneurysm of Internal Carotid Artery — A Case Report

蔡東華(Dong-HwaTsai) ； 林世鐸(Shi-Dou Lin)

《內科學誌》 26卷5期 (2015/10) Pp. 295-298

摘要

從海綿竇內內頸動脈(internal carotid artery)所產生的巨大動脈瘤雖然非常罕見但卻重要。它可延伸到蝶鞍(sella)，表現出如同腦下垂體腺瘤(pituitary adenoma)引起腦下垂體功能障礙。我們報告一個因蝶鞍上顱內巨大動脈瘤，導致腦下垂體功能不足和高泌乳素血症的病例。這名49歲的婦女以視力逐漸模糊併視野缺損來我們醫院就診，進一步檢查發現腦下垂體功能低下(pituitary insufficiency)和高泌乳素血症(hyperprolactinemia)。她的腦下垂體磁振掃描(MRI)和腦血管造影檢查顯示在右側遠端內頸動脈出現不規則囊狀動脈瘤。她接受頸動脈內透過支架送入線圈實施動脈瘤栓塞手術，以縮小動脈瘤的佔位效應。一年半後追蹤顯示，腦下垂體的功能部分恢復，泌乳激素(prolactin)血清值降低，視野部分恢復正常。蝶鞍上顱內動脈瘤常常有類似腦下垂體瘤的外觀和臨床表現，如果沒有被及時的加以診斷及治療，有可能導致臨床嚴重的後果。

關鍵字

腦下垂體功能不足 ； 高泌乳素血症 ； 巨大內頸動脈瘤 ； 腦下垂體腺瘤 ； 磁振掃描血管造影 ； 電腦斷層血管造影

並列摘要

Giant aneurysms originate from the cavernous internal carotid artery (ICA) is a very rare but important condition. It can extend into the sella and simulate pituitary adenomas, sometimes present with pituitary dysfunction. We report a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. The 49-year-old woman presented at our institution with symptoms of visual field defect, hypopituitarism and hyperprolactinemia were found after investigation. Her pituitary MRI and cerebral angiography revealed a giant irregular saccular aneurysm over right distal internal carotid artery. Transarterial embolization through stent insertion and then coiling was performed on the patient to decrease the mass effect of aneurysm. After treatment, her one and half year follow-up showed decrease of prolactin (PRL) level,partially recovery of pituitary function and visual field. An suprasellar intracranial aneurysm can often simulate the appearance and behavior of a pituitary tumor, potentially resulting in serious outcomes if they are not appropriately recognized.

並列關鍵字

Pituitary insufficiency ； Hyperprolactinemia ； Giant aneurysm of internal carotid artery ； Pituitary adenoma ； Magnetic resonance angiography ； MRA ； Computed tomographic angiography ； CTA