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Bilateral Cerebral Aneurysms Impinging on the Pituitary
By Theodore C. Friedman, M.D., Ph.D., Hrayr Shahinian, M.D.
Legend
A 41-year-old female presented with buzzing in her head, insomnia, fatigue, depression, decreased
libido and irregular periods. Partial hypopituitarism was suspected and laboratory evaluation revealed a low
normal IGF-1 of 135 ng per deciliter (118-298 per deciliter) with normal thyroid and cortisol axes. An
arginine-GHRH stimulation test of growth hormone (GH) revealed a peak GH by RIA of 5.2 ng per
milliliter (> 9 ng per milliliter). A dynamic pituitary MRI (Panel A) revealed a left cavernous carotid
aneurysm, impinging upon the left side of the anterior pituitary. A cerebral angiogram demonstrated a 3 mm
cavernous aneurysm in the right carotid artery (Panel B) and a 7 mm cavernous aneurysm in the left carotid
artery (Panel C). Because there was no intradural extension, surgery was not indicated and the patient was
instructed to maintain normal blood pressure. She was started on recombinant human GH with
improvement in energy and sleep.
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