Article
Intracranial aneurysms in patients with acromegaly – should we screen for them?
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Authors
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Agnieszka Grzywotz
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Deutschland
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Ilonka Kreitschmann-Andermahr
- University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
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Daniela Müller
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Deutschland
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Nicole Unger
- Department of Endocrinology and Metabolism and Division of Laboratory Research, University Hospital Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Deutschland
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Adrian Ringelstein
- Institut für Radiologie, Institute for Diagnostic and Interventional Radiology and Neuroradiology, Düsseldorf, Deutschland
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Ulrich Sure
- Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
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Oliver M. Müller
- Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Patients with acromegaly suffer of a number of comorbidities, related to growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess, caused by the GH secreting pituitary adenoma. Next to somatic disfigurement and arthralgia, systemic complications include diabetes, cardiovascular disease, and hypertension. Another comorbidity of relevance for the neurosurgeon which has recently come to the focus of attention is the reportedly increased incidence of intracranial aneurysms found in patients with acromegaly.
Methods: Case study of three patients with acromegaly and intracranial aneurysms, one of them ruptured, who were treated within the last 3 years in our neurosurgical department.
Results: 2 out of 13 patients with clinically and biochemically proven acromegaly admitted to our department for pituitary surgery since 2014 presented with chance findings of intracranial aneurysms, one located at the pericallosal artery (5,6 x 6,6 mm) and one located at the anterior communicating artery (5 x 8 x 9 mm). A further patient operated in 2008 for a GH producing pituitary adenoma and still active acromegaly due to medication incompliance was admitted to our neurosurgical intensive care ward with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage due to a ruptured anterior communicating artery aneurysm. Additionally, he harbored an unruptured middle cerebral artery aneurysm. The ruptured aneurysm was coiled successfully, but the further clinical course was complicated by vasospasm and development of hydrocephalus necessitating shunt insertion.
Conclusion: Our small case series shows a high number of unruptured aneurysms in patients with acromegaly as well as a case of SAH with severe clinical consequences. This observation is in line with two cross-sectional studies: the first having found that 26/152 acromegaly patients (17.3%) investigated by means of MRI imaging of intracranial vessels harbored 40 newly diagnosed aneurysms, and the second describing a with 6.9% increased prevalence of intracranial aneurysms in male acromegaly patients in comparison to 1.6% in the control group. Considering the fact that patients with acromegaly have comorbidities that are risk factors for aneurysm rupture, neurosurgeons should take into account the potentially increased prevalence of aneurysms in this patient group, especially against the background that MRI screening for intracranial aneurysms can be effected during routine presurgical work-up.
