Abstract
Pituitary adenomas, the second most common intracranial pathology, often exhibit symptoms beyond the classic triad of headache, visual disturbances, and hormonal imbalances. Unusual presentations involve sinonasal pathology, cranial nerve involvement, and mass effects on adjacent structures like the skull base. Secretory adenomas may manifest hormonal changes and their effects. A 43-year-old hypertensive male presented with progressive nasal obstruction. Nasal endoscopy revealed a mass in the left nasal cavity. MRI and histopathology confirmed a pituitary adenoma diagnosis. A 58-year-old male with hoarseness and inspiratory stridor exhibited acromegalic features and vocal cord palsy. Imaging revealed a pituitary adenoma. ENT specialists must recognize varied presentations of pituitary adenomas, which may include sino-nasal issues, cranial nerve deficits or even voice/airway disorders. Early detection allows for effective management, emphasizing interdisciplinary collaboration and prioritizing airway protection in severe cases.