Singh Chandra Veer, Jain Shraddha
Otolaryngology - Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Cureus. 2024 Sep 6;16(9):e68783. doi: 10.7759/cureus.68783. eCollection 2024 Sep.
Pituitary macroadenomas are benign tumors that typically present with symptoms of hormonal imbalance or visual disturbances due to their location and size. However, in rare instances, these tumors can extend beyond the sellar region into the nasal cavity, leading to unusual clinical presentations. This case report describes a 63-year-old woman who presented with progressive nasal obstruction, episodes of dizziness, and occasional headaches. Physical examination revealed a large, firm mass in the nasopharynx. Nasal endoscopy and computed tomography (CT) imaging confirmed the presence of a pituitary macroadenoma measuring 7.3 x 4 x 4.9 cm, extending from the pituitary gland through the sphenoid sinus into the nasal cavity. The tumor did not affect the optic chiasm despite its significant size, as evidenced by normal visual field tests. The patient underwent successful endoscopic transnasal resection of the tumor, a minimally invasive procedure that allowed for complete removal with minimal morbidity. Postoperative recovery was uneventful, and follow-up imaging showed no residual tumor. The patient reported a significant improvement in symptoms, particularly the resolution of nasal obstruction and headaches. Histopathological examination confirmed the diagnosis of a pituitary macroadenoma. This case highlights the rare presentation of pituitary macroadenomas as nasal masses and emphasizes the importance of considering this diagnosis in patients with atypical nasal symptoms. The successful outcome following endoscopic transnasal surgery demonstrates the effectiveness of this approach in managing complex pituitary adenomas with extensive extracranial extension.
垂体大腺瘤是良性肿瘤，通常因其位置和大小而出现激素失衡或视觉障碍症状。然而，在罕见情况下，这些肿瘤可延伸至鞍区以外进入鼻腔，导致不寻常的临床表现。本病例报告描述了一名63岁女性，她出现进行性鼻塞、头晕发作和偶尔头痛。体格检查发现鼻咽部有一个大而硬的肿块。鼻内镜检查和计算机断层扫描（CT）成像证实存在一个7.3×4×4.9厘米的垂体大腺瘤，从垂体经蝶窦延伸至鼻腔。尽管肿瘤体积较大，但视野测试正常，证明肿瘤未影响视交叉。患者接受了成功的内镜经鼻肿瘤切除术，这是一种微创手术，能够在发病率极低的情况下完全切除肿瘤。术后恢复顺利，随访成像显示无残留肿瘤。患者报告症状有显著改善，尤其是鼻塞和头痛症状得到缓解。组织病理学检查证实为垂体大腺瘤。本病例突出了垂体大腺瘤作为鼻腔肿物的罕见表现，并强调了在有非典型鼻部症状的患者中考虑这一诊断的重要性。内镜经鼻手术后的成功结果证明了这种方法在处理具有广泛颅外延伸的复杂垂体腺瘤方面的有效性。
