Pituitary Macroadenoma Presenting with Complete Nasal Obstruction: A Case Report and Literature Review

Case: A 58-year-old lady presented with worsening congestion, nasal obstruction, and hyposmia. After failing medical therapy, imaging demonstrated a massive tumor (6.1 cm × 3.9 cm × 5.2 cm) in the nasal cavity with erosion through the skull base superiorly and the clivus inferiorly (Fig. 1). At this point she was referred to our center where she underwent urgent biopsies that demonstrated a pituitary adenoma. Formal visual testing showed decreased visual acuity in the right eye. She then underwent successful endoscopic resection of the tumor with significant improvement clinically.

Fig. 1 A large mass obliterates the sphenoid and posterior ethmoidal air cells.

Review of the Literature: The literature on pituitary adenomas was reviewed. Pituitary adenomas are relatively common lesions and represent ~15% of all intracranial neoplasms. The presentation can be varied, but often patients present with headache, endocrinological disturbances, or visual changes. Nasal obstruction is a very rare presentation of a pituitary adenoma, but has been described in the literature, first being described in 1910.

In the workup of a large nasal mass, imaging and histological exam is essential. The differential for nasal obstruction is rare, but pituitary tumors (including adenoma) should be on the differential and kept in the back of the mind whenever a patient presents with a large posteriorly-based sinonasal mass.