Invasive pituitary adenoma presenting with cerebrospinal fluid rhinorrhea and meningitis – A case report

Abstract

Background: Most pituitary neuroendocrine tumors are benign, except some adenomas that show invasiveness and are called invasive pituitary adenomas. These are challenging and rare pathologies. Case Description: We present a case of a 40-year-old male who presented to the emergency with seizures, rhinorrhea, headache, and drowsiness. Radiology images showed a sellar mass with supra-sellar extension and pneumocephalus. The pituitary profile was within normal limits. The patient underwent bifrontal craniotomy and maximum safe resection of the lesion with cerebrospinal fluid (CSF) leak repair and lumbar drain insertion. Histological examination and immunohistochemical stain were consistent with pituitary adenoma. Postoperatively, there was no CSF leak, and the patient’s Glasgow Coma Scale improved. Conclusion: Rhinorrhea is a unique presentation for pituitary adenoma. According to the current literature, surgery is the only effective treatment as part of the management of invasive pituitary adenomas, along with a multidisciplinary approach.