Further evaluation of transient elastography to assess LSM is required in prospective studies to potentially increase the sensitivity and establish its clinical utility.

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Giant carotid aneurysms are a rare cause of hypopituitarism with a prevalence of 0.17%, usually causing irreversible hypopituitarism. 1 Intracranial aneurysms may mimic pituitary adenomas in both appearance and behaviour and should be considered as a differential diagnosis of hypopituitarism and hyperprolactinaemia. 2 Pre-operative diagnosis is vital for a successful outcome in those undergoing surgery, as erroneous diagnosis of an adenoma could potentially result in severe perioperative haemorrhage. 1,3 Definitive diagnosis is often reached with computed tomography angiography to demonstrate arterial enhancement and direct communication with the internal carotid artery 3 , as was seen in the case we present. This is a rare and interesting case of hypopituitarism secondary to a carotid artery aneurysm complicating a new presentation of hepatocellular carcinoma. There are approximately 40 cases of hypopituitarism due to cerebral aneurysm reported in the literature 2 and one case described as a first presentation of a gastric carcinoma. 4 However, to our knowledge, this is the first reported case of a giant carotid artery aneurysm associated with hepatocellular carcinoma or portal vein thrombosis.