A rare case of invasive pituitary tumor mimicking nasal mass

Abstract

Pituitary apoplexy is a rare condition more often seen in large pituitary adenomas. It is preceded by an abrupt expansion of infarcted/hemorrhagic pituitary adenoma extending into the cavernous sinus or superiorly compressing the optic chiasm. An invasive pituitary tumor extends into the suprasellar cistern by stretching and fenestrating the diaphragma sellae and arachnoids layer. It is labeled as invasion of the cavernous sinus when the percentage of encasement of the internal carotid artery by the tumor is 67% or greater or for Grade 3 or 4 of Knosp classification. A 51-year-old male presented with headache, vomiting, and bleeding from the nose for 3-day duration and blurring of vision for 2-day duration. Contrast-enhanced magnetic resonance imaging of the brain revealed an enhancing sellar and suprasellar lesion with characteristic expansion into the cavernous sinus and extension into the sphenoid sinus and nasopharynx. The patient underwent endoscopic transnasal transsphenoidal excision of the mass followed by three-dimensional conformational radiotherapy and hormone replacement therapy with a favorable clinical outcome.