Pituitary adenoma presenting with nasal obstruction: A case report

Case: A 58-year-old lady presented with worsening congestion, nasal obstruction, and hyposmia. After failing medical therapy, a computed tomography (CT) scan was ordered which demonstrated a large tumor (6.1 cm × 3.9 cm x 5.2cm) in the nasal cavity. There was erosion through the skull base superiorly and the clivus inferiorly (Fig. 1). At this point she was referred to our center where she underwent endoscopic 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. Review of the literature: Pituitary adenomas are relatively common lesions and represent approximately 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 large, 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.