Nasopharyngeal presentation of pituitary tumors. Differential diagnosis and treatment

The intranasal presentation of pituitary tumors is rare. We describe six patients with supposedly intranasal carcinomas, treated by surgery, local chemotherapy, and/or radiotherapy. Because of the favorable clinical course, immunohistochemical reexamination of tumor tissue was done, which showed a macroprolactinoma in four and a nonfunctioning pituitary adenoma in two patients. Interestingly, anterior pituitary function was normal in four and only slightly disturbed in two of them. The radiological appearance of the sellar region was completely normal in two patients. Routine immuno-histochemistry would have prevented inappropriately aggressive therapy. Dopamine agonist therapy was effective in the four macroprolactinoma patients, but the nasopharyngeal localization of the tumor seems to increase the risk of rhinorrhea and/or meningitis.