{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:10:07Z","timestamp":1756311007352,"version":"3.44.0"},"reference-count":25,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,4,10]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>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\u2019s 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.<\/jats:p>\n               <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2023-258533","type":"journal-article","created":{"date-parts":[[2024,4,20]],"date-time":"2024-04-20T03:45:11Z","timestamp":1713584711000},"page":"e258533","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Beware of epistaxis: fatal pseudoaneurysm rupture 30 years after treatment of acromegaly"],"prefix":"10.1136","volume":"17","author":[{"given":"Ana","family":"Carreira","sequence":"first","affiliation":[{"name":"Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"},{"name":"Department of Endocrinology, Diabetes and Metabolism, Hospitais da Universidade de Coimbra, Unidade Local de Sa\u00fade de Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Muna","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley B","family":"Grossman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e1rta","family":"Korbonits","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,4,19]]},"reference":[{"key":"2025082708523360000_17.4.e258533.1","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.01863"},{"key":"2025082708523360000_17.4.e258533.2","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/s41574-018-0058-5","article-title":"A consensus statement on Acromegaly therapeutic outcomes","volume":"14","author":"Melmed","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"2025082708523360000_17.4.e258533.3","first-page":"s261","article-title":"Carotid artery injury during endoscopic Endonasal skull base surgery: incidence and outcomes","volume":"73","author":"Gardner","year":"2013","journal-title":"Neurosurgery"},{"key":"2025082708523360000_17.4.e258533.4","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci11010099","article-title":"Internal carotid artery injury in Transsphenoidal surgery: tenets for its avoidance and Refit-A 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