Endoscopic Resection of Pituitary Macroadenomas Extending Into the Nasal Cavity: A Case Report and Literature Analysis

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.