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

Abstract

PurposeEndonasal 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.MethodsA systematic review following the PRISMA statement was performed in July 2021.ResultsThirty-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.ConclusionsThere 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.