Allergic Fungal Sinusitis presenting with Hypopituitarism: A Case Report and Literature Review

Case report


Ali B. Khalil, Donald (Jr) Roberts

Center for Diabetes and Endocrinology, Department of Head and Neck Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

IJMBS 2010, 2(2):92-97


Allergic fungal sinusitis is a form of noninvasive chronic sinusitis. In this report, we describe the successful treatment of a patient with allergic fungal sinusitis and Hypopituitarism. A 41 year old female presented with history of nasal obstruction, anosmia, right periorbital headache and amenorrhea. The diagnosis of allergic fungal sinusitis was made using nasal endoscopy, CT scan and MRI of head and paranasal sinuses. There was nearly complete obliteration of the paranasal ethmoid, maxillary and sphenoid sinuses with erosion of the medial wall of the right orbit and a displacement of the right globe and medial rectus and effacement of the pituitary gland. Sphenoid sinus showed fluid containing free hyphae, but no fungal invasion of mucosa was noted. Pituitary assessment revealed anterior pituitary insufficiency. Bilateral endoscopic ethmoidectomy and transnasal and transseptal bilateral sphenoidotomy were performed. After 3 months of follow up on hormone replacement therapy and antifungal therapy, the patient’s headache, anosmia, and nasal obstruction were completely relieved, menses resumed and the patient’s pituitary function recovered.

Keywords: Allergic fungal sinusitis; Pituitary abscess; Aspergillus; Paranasal sinuses; Hypopituitarism; Transseptal sphenoidotomy.