Acromegaly Presenting as Non-Sellar Pituitary Adenoma of the Skull Base: Case Report and Literature Review

Objectives: Non-sellar pituitary tumors are exceedingly rare and are believed to arise from ectopic tissue which persists after involution of the craniopharyngeal duct. We describe a case of a non-sellar pituitary adenoma presenting as a sinonasal mass with skull base erosion and acromegaly. Methods: Case report and review of the literature. Case Report: A 46-year-old male presented to urgent care with nasal congestion, severe headache, and new onset diplopia. Contrast-enhanced CT and MRI demonstrated a mass involving the ethmoid and sphenoid sinuses, with associated invasion of the cavernous sinus, bone destruction of the central skull base and planum sphenoidale, and no sellar lesion. Treatment with antibiotics and topical nasal steroids improved his nasal symptoms and headache. He was also noted to have clinical features of acromegaly. Biopsy of the posterior ethmoid mass demonstrated a pituitary adenoma, growth-hormone secreting. The patient was started on somatostatin analog therapy. Conclusions: Though pituitary adenomas are not uncommon, they rarely present with sinonasal symptoms. Symptoms of acromegaly and other pituitary dysfunction can help skull base surgeons diagnose non-sellar pituitary masses.