Atypical presentation of a sphenoid sinus mucocele: vision loss, partial hypopituitarism, adrenal insufficiency and SIADH

Atypical presentation of a sphenoid sinus mucocele: vision loss, partial hypopituitarism, adrenal insufficiency and SIADH. Background and objective: Paranasal sinus mucoceles are mucus-containing benign cysts arising from the paranasal sinus mucosa. Sphenoid sinus mucoceles (SSMs) comprise only 1-2% of all paranasal sinus mucoceles. The clinical presentation of SSMs varies widely, contingent on what nearby structures are affected. Case: We present a unique case of SSM presenting with pituitary stalk dysfunction (causing hyperprolactinemia), hypopituitarism (manifesting as subclinical hypothyroidism and hypocortisolaemia), SIADH, adrenal insufficiency (due to the hypocortisolaemia), anosmia and chronic unilateral vision loss. Summary and conclusion: Based on an extensive literature search, this is the first reported case of an SSM resulting in such a unique constellation of endocrine abnormalities, vision loss and anosmia. This case highlights that, even with severe, chronic symptoms, surgical intervention can lead to complete symptom resolution with a return to baseline functioning.