ICA Occlusion by an ACTH- secreting pituitary adenoma post-TSS and irradiation

Abstract

Occlusion of intracranial arteries by a pituitary adenoma with ensuing infarction is a rare occurrence. In this case study, we show the instance of a pituitary  macroadenoma and apoplexy causing mechanical obstruction of the internal carot- id artery with consequent infarction following transphenoidal surgery (TSS) and ra- diation therapy in a patient with Cushing’s disease. we report a 44-year-old woman  presented with amenorrhea and headaches. Necessary investigations, resection by  TSS, and microscopic examination revealed an adenocorticotropin (ACTH)-secret- ing pituitary macroadenoma. The pituitary tumour recurred in subsequent years,  resulting in the development of Cushing’s disease and syndrome. despite two more  transphenoidal surgeries, radiotherapy, and medical suppressive therapy, the pi- tuitary adenoma continued to enlarge, and the hypercortisolemia and Cushingoid  symptoms persisted. A craniotomy was arranged as the next step in the treatment strategy. Only hours prior to the scheduled surgery, the patient developed left-sided hemiplegia, was diagnosed with acute occlusion of the right ICA and underwent an emergency bifrontal craniotomy with evacuation of the tumour and decompression.  Pathological examination revealed evidence of apoplexy in the ACTH-secreting pi- tuitary adenoma. This case demonstrates the vast scope of complications that can  arise from pituitary adenomas despite combination therapy and forewarns clinicians to be prepared to manage these infrequent but conceivable occurrences.