Abstract 106: Thrombosed Intrasellar aneurysm with Panhypopituitarism: A case report

Case Report: A 45 years male married with 3 kids, former smoker and no underlying comorbidities presented to medical emergency with sudden onset heaviness of head in occipital area and lightheadedness at around 8 pm. It was followed by excessive generalised sweating and altered sensorium in the form of unresponsiveness that lasted for 5- 10 minutes. During same period he developed urinary incontinence. He had no episode of abnormal body movements. His Blood pressure was 140/100 mmHg, GCS was 15/15, Pupils Bilateral normal size with reaction to light present. Systemic examination was normal. Random Blood glucose was 92 mg/dl. Noncontrast CT brain was advised that showed 13.8 X 9.3 mm well- delineated hyperdense lesion in the region of sella [Figure 1] with Subarachnoid haemorrhage. MR angiography was done that showed narrow neck giant aneurysm at C5 segment of distal ICA and ophthalmic artery is arising from base of the aneurysm. Cerebral angiogram was performed that confirmed the findings and after that balloon assisted coiling of aneurysm was done and flow diverter was placed across left Internal carotid artery – terminal [ophthalmic] segment. Check angiogram revealed no filling or recurrence of aneurysm with good filling of ophthalmic artery. He developed transient mild hyponatremia post procedure and got improved with normal saline. After 15 days from discharge from hospital, he started with dryness of mouth, increase in thirst and craving for cold water. Also he noticed increased frequency of micturition so much so that he had to get up 4-5 times during night to pass urine. His appetite also decreased. No associated nausea or vomiting. He also developed cold intolerance and erectile dysfunction over one-and-a-half-month period. With these complaints, he visited Outpatient department. Hormone evaluation revealed, Total T4 7.63 mcg/dl, Cortisol 0.72 mcg/dl, FSH 1.23 IU/L, LH 0.87 IU/L, Testosterone 28.28 ng/dl, Prolactin 16.74 ng/ml, Serum Sodium 148, Potassium 3.78, 24 hour urinary volume 4.5 litres. Serum osmolality 304 mosml/l, Urine osmolarity 121 mosm/l. He was started on prednisolone 5 mg, Thyroxine 50 mcg, Desmopressin 0.1 mg bedtime and testosterone injections 100 mg Intramuscular every 21 days. He noticed improvement in his symptoms within 3 days of starting treatment and hypernatremia also settled. Contrast MRI sella was done after 3 months from procedure and noted 15 X 10 mm T1/T2 hypointense area in suprasellar location likely thrombosed aneurysm causing mass effect on pituitary stalk and pituitary bright spot not seen.