Pituitary macroadenomas usually present with symptoms due to a local mass effect or to hormone abnormalities. Acromegaly is due an excessive GH production, usually caused by a slow-growing pituitary adenoma. Acromegaly is an insidious disease. An average delay of 7 years is reported between the time of symptoms onset and diagnosis. According to main symptoms, acromegaly is usually diagnosed by internists, ophthalmologists or rheumatologists. It may be suspected by pneumologists in case of sleep apnea syndrome. Only exceptionally otorhinolaryngologists diagnose the disease, even if nasal polyps may be present in up to 5% of patients. We discuss here the unusual case of a 34-year-old woman who presented to an otorhinolaryngologist with persistent nasal congestion and forehead pain, unresponsive to antibiotic and anti-inflammatory treatment. Nasal endoscopy confirmed the presence of nasal polyps. Computed tomography of paranasal sinuses showed massive mucosal hypertrophy with a voluminous polypoid intranasal lesion. Transnasal biopsy demonstrated the presence of pituitary tissue. Hormonal evaluation showed a very high serum IGF-I (1185 ng/ml) and an increased serum growth hormone (48 ng/ml), leading to the diagnosis of acromegaly. The patient underwent transphenoidal surgery and histology confirmed the presence of a GH secreting adenoma. Intranasal presentations of pituitary tumours are uncommon. This case illustrates that pituitary lesions may present as polyps invading nasal cavities. To our knowledge only ten cases have been reported in literature (seven macroprolactinomas, two nonsecreting adenomas and one macroadenoma with ACTH immunopositivity). In all the reported cases initial diagnosis was that of a nasal polyp or of an intranasal carcinoma. We conclude that in a patient with nasal polyps, looking for clinical signs of Cushing syndrome or of acromegaly and subsequent hormonal evaluation could be of help for an early diagnosis.
27 Apr - 01 May 2013
European Society of Endocrinology