[en] 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.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Spille, Dorothee Cäcilia; Department of Neurosurgery, University Hospital of Münster, Münster, Germany
Vorona, Elena; Department of Medicine B of Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology Division for Endocrinology and Diabetes, Münster, Germany
Catalino, Michael P.; The University of Texas, MD Anderson Cancer Center, Houston, United States
Reuter, Gilles ; Centre Hospitalier Universitaire de Liège - CHU > > Service de neurochirurgie
Beckers, Albert ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'endocrinologie clinique
Holling, Markus; Department of Neurosurgery, University Hospital of Münster, Münster, Germany
Fava, Arianna; Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy
Stummer, Walter; Department of Neurosurgery, University Hospital of Münster, Münster, Germany
Laws, Edward R.; Department of Neurosurgery, Brigham and Women’s Hospital, Boston, United States
Suero-Molina, Eric; Department of Neurosurgery, University Hospital of Münster, Münster, Germany
Language :
English
Title :
Vascular anomalies in patients with growth hormone-secreting pituitary adenomas: illustrative case report and systematic review of the literature
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