Allergic fungal sinusitis presenting with hypopituitarism: A case report and literature review

Abstract

Allergic fungal sinusitis is a form of noninvasive chronic sinusitis. In this report, we describe the successful treatment of a patient with allergic fungal sinusitis and hypopituitarism. A 41 year old female presented with history of nasal obstruction, anosmia, right periorbital headache, and amenorrhea. The diagnosis of allergic fungal sinusitis was made using nasal endoscopy, CT scan and MRI of head and paranasal sinuses. There was nearly complete obliteration of the paranasal ethmoid, maxillary, and sphenoid sinuses with erosion of the medial wall of the right orbit. In addition, there was displacement of the right globe and medial rectus, and effacement of the pituitary gland. The sphenoid sinus showed fluid containing free hyphae, but no fungal invasion of mucosa was noted. Pituitary assessment revealed anterior pituitary insufficiency. Bilateral endoscopic ethmoidectomy and transnasal and transseptal bilateral sphenoidotomy were performed. After three months of follow up on hormone replacement and antifungal therapy, the patient's headache, anosmia, and nasal obstruction were completely relieved, menses resumed, and the patient’s pituitary function had recovered.