Vascular anomalies in patients with growth hormone-secreting pituitary adenomas: illustrative case report and systematic review of the literature.

Abstract

PURPOSE:

Endonasal resection is the first-line treatment for patients harboring growth hormone (GH)-secreting pituitary adenomas. The complexity of the parasellar neurovascular structures makes pre-operative diagnostic imaging essential to understanding the anatomy of this region. We aimed to describe vascular anomalies in acromegalic patients and emphasize their relevance for surgery and preoperative planning.

METHODS:

A systematic review following the PRISMA statement was performed in July 2021.

RESULTS:

Thirty-three studies were evaluated. Elevated GH and insulin-like growth factor-1 (IGF-1) levels are linked to the occurrence of cardiovascular risk factors. This is attributed to endothelial dysfunction, mainly caused by changes in flow-mediated dilatation (FMD), which is probably the main cause of vascular anomalies in acromegaly. The occurrence of protrusions of the internal carotid artery (ICA) (35-53%), a narrow intercarotid distance, and an asymmetrical course was described. In 13-18% of acromegalic patients, the presence of an intracerebral aneurysm could be reported (incidence in the general population:0.8-1.3%). The selected studies were however performed with a small patient sample (range:1-257). We present a case report of a 57y/o male patient with anomalies of the ICA ("kissing carotid arteries") harboring a GH-secreting adenoma, which was resected via an endoscopic endonasal approach.

CONCLUSIONS:

There is an association between acromegaly and endothelial dysfunction, which increases cardiovascular risk factors and vascular anomalies. Preoperative vascular imaging, e.g., CT angiography, should be implemented as a standard to identify patients at risk and estimate surgical morbidity. However, no evidence-based recommendations exist so far, so future studies are necessary.

• Authors: Dorothee Cäcilia Spille, Elena Vorona, Michael P Catalino, Gilles Reuter, Albert Beckers, Markus Holling, Arianna Fava, Walter Stummer, Edward R Laws, Eric Suero-Molina
• Journal: Pituitary (Pituitary) Vol. 26 Issue 1 Pg. 132-143 (Feb 2023) ISSN: 1573-7403 [Electronic] United States
• PMID: 36508085 (Publication Type: Systematic Review, Case Reports, Journal Article)
• Copyright: © 2022. The Author(s).

Chemical References

• Human Growth Hormone

Topics

• Humans
• Male
• Acromegaly (surgery)
• Adenoma (complications)
• Growth Hormone-Secreting Pituitary Adenoma (complications)
• Human Growth Hormone
• Pituitary Neoplasms (complications)
• Middle Aged