Neurological Surgery 脳神経外科48巻8号

2020年08月発行

症例

汎下垂体機能低下症を呈した未破裂内頚動脈瘤の治療後，内分泌学的機能の改善が得られた1例

著者： 本間博¹ 伊藤美以子¹ 下川友侑¹ 川並香菜子¹ 山木哲¹ 小久保安昭¹ 園田順彦¹

所属機関： ¹山形大学医学部脳神経外科

ページ範囲：P.733 - P.738

Ⅰ．はじめに
　成人下垂体機能低下症の原因として，本邦の報告では腫瘍性病変が多く，その内訳は下垂体腺腫が27.4%であり，次いで特発性21.5%，頭蓋咽頭腫13.3%，胚芽腫7.3%, Sheehan症候群6.4%と報告されている¹⁸⁾．一方で，頭蓋内動脈瘤が原因で汎下垂体機能低下症を呈することは0.17%と稀であり⁶⁾，内分泌機能の回復に関するまとまった報告はなく，詳細は不明である^6,13,16)．今回われわれは，汎下垂体機能低下症を呈した未破裂内頚動脈瘤の治療後，内分泌学的機能の改善が得られた1例を経験したので報告する．

参考文献

1) Ding D, Mehta GU, Liu KC：Pituitary insufficiency from large unruptured supraclinoid internal carotid artery aneurysm. Br J Neurosurg 28：290-292, 2014

2) Fernández-Real JM, Fernández-Castañer M, Villabona C, Sagarra E, Gómez-Sáez JM, Soler J：Giant intrasellar aneurysm presenting with panhypopituitarism and subarachnoid hemorrhage：case report and literature review. Clin Investig 72：302-306, 1994

3) Giustina A, Scalvini T, Cerudelli B, Bossoni S, Bodini C, Orlandini A, Romanelli G：Hypopituitarism secondary to suprasellar giant carotido-ophthalmic aneurysm. Normalization of the hypophyseal function after neurosurgical depression of the aneurysm. Minerva Endocrinol 14：255-258, 1989［Article in Italian］

4) Gungor A, Gokkaya N, Bilen A, Bilen H, Akbas EM, Karadeniz Y, Eren S：Pituitary insufficiency and hyperprolactinemia associated with giant intra-and suprasellar carotid artery aneurysm. Case Rep Med 2015：536191, 2015

5) Hanak BW, Zada G, Nayar VV, Thiex R, Du R, Day AL, Laws ER：Cerebral aneurysms with intrasellar extension：a systematic review of clinical, anatomical, and treatment characteristics. J Neurosurg 116：164-178, 2012

6) Heshmati HM, Fatourechi V, Dagam SA, Piepgras DG：Hypopituitarism caused by intrasellar aneurysms. Mayo Clin Proc 76：789-793, 2001

7) Klose S, Kopf D, Lehnert H：Giant intrasellar carotid aneurysm—an unusual cause of panhypopituitarism. Exp Clin Endocrinol Diabetes 113：551-553, 2005

8) Lawson EA, Buchbinder BR, Daniels GH：Hypopituitarism associated with a giant aneurysm of the internal carotid artery. J Clin Endocrinol Metab 93：4616, 2008

9) Ono H, Inoue T, Kunii N, Tanishima T, Tamura A, Saito I, Saito N：Giant cavernous carotid aneurysm causing pituitary dysfunction：pituitary function recovery with high-flow bypass. Surg Neurol Int 8：180, 2017

10) Orozco LD, Buciuc RF：Balloon-assisted coiling of the proximal lobule of a paraophthalmic aneurysm causing panhypopituitarism：technical case report Surg Neurol Int 2：59, 2011

11) Qi M, Ye M, Li M, Zhang P：Pituitary dysfunction from an unruptured ophthalmic internal carotid artery aneurysm with improved 2-year follow-up results：a case report. Open Med（Wars）13：137-141, 2018

12) Rodríguez-Catarino M, Frisén L, Wikholm G, Elfverson J, Quiding L, Svendsen P：Internal carotid artery aneurysms, cranial nerve dysfunction and headache：the role of deformation and pulsation. Neuroradiology 45：236-240, 2003

13) Tan LA, Sandler V, Todorova-Koteva K, Levine L, Lopes DK, Moftakhar R：Recovery of pituitary function following treatment of an unruptured giant cavernous carotid aneurysm using Surpass flow-diverting stents. BMJ Case Rep 2014：bcr2014011233, 2014

14) Tanaka K, Ishida F, Tanioka S, Kishimoto T, Shimosaka S, Suzuki H：Transient aggravation of hypopituitarism after parent artery occlusion with low-flow bypass for unruptured giant cavernous carotid aneurysm. World Neurosurg 123：339-342, 2019

15) Tungaria A, Kumar V, Garg P, Jaiswal AK, Behari S：Giant, thrombosed, sellar-suprasellar internal carotid artery aneurysm with persistent, primitive trigeminal artery causing hypopituitarism. Acta Neurochir（Wien）153：1129-1133, 2011

16) Verbalis JG, Nelson PB, Robinson AG：Reversible panhypopituitarism caused by a suprasellar aneurysm：the contribution of mass effect to pituitary dysfunction. Neurosurgery 10：604-611, 1982

17) Wijethunga WMUA, Dissanayake HA, Perera S, Katulanda P：Intra cavernous aneurysm of internal carotid artery masquerading as a pituitary adenoma：a case report. BMC Res Notes 11：237, 2018

18) 横山徹爾，村上宣男，加藤　譲，大磯ユタカ，玉腰暁子，川村　孝，田中平三，稲葉　裕：成人下垂体機能低下症の全国疫学調査成績．厚生労働省厚生科学研究補助金特定疾患対策研究事業　間脳下垂体機能障害に関する調査研究班（主任研究者　加藤　譲）平成13年度総括研究事業報告書．2001, pp.161-169