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Beware of epistaxis: fatal pseudoaneurysm rupture 30 years after treatment of acromegaly
  1. Ana Carreira1,2,
  2. Solomon Muna1,
  3. Ashley B Grossman1 and
  4. Márta Korbonits1
  1. 1Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2Department of Endocrinology, Diabetes and Metabolism, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
  1. Correspondence to Márta Korbonits; m.korbonits{at}qmul.ac.uk

Abstract

We present a fatal complication of treatment in a patient with early-onset acromegaly, treated with two transsphenoidal operations, radiotherapy, radiosurgery and pegvisomant. He was diagnosed in his 30s, and controlled from his 40s, with stable residual tumour within the left cavernous sinus. In his 60s, 30 years after surgery/radiotherapy and 14 years after radiosurgery, he developed recurrent episodes of mild epistaxis. A week later, he presented at his local hospital’s emergency department with severe epistaxis and altered consciousness. He was diagnosed with a ruptured internal carotid artery (ICA) pseudoaneurysm, but unfortunately died before treatment could be attempted.

ICA pseudoaneurysms are rare complications of surgery or radiotherapy and can present with several years of delay, often with epistaxis. This case highlights the importance of life-long monitoring in patients with previous pituitary interventions and early recognition of epistaxis as a herald sign of a potentially catastrophic event, thus leading to timely treatment.

  • Pituitary disorders
  • Neurosurgery
  • Ear, nose and throat/otolaryngology
  • Radiotherapy

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: AC, SM, ABG and MK. AC and SM were responsible for data collection and drafting the article. ABG and MK were involved in the clinical care of the patient and were responsible for the critical revision and scientific appraisal of the manuscript. MK is responsible for the overall content as guarantor. The following authors gave final approval of the manuscript: AC, SM, ABG and MK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.