Dear Sirs,although transsphenoidal pituitary surgery has to be considered effective and safe, with mortality rates well <1 in expert centers, it may carry some potentially serious complications (1). We would like to draw attention to mucocele of the sphenoid sinus as a rare late complication which, if not recognized promptly, may cause serious visual consequences (2). We here describe the occurrence of monolateral visual loss due to sphenoid sinus mucocele 18 yr after transsphenoidal surgery for a GH secreting pituitary macroadenoma. A 72-yr-old woman was admitted to our Institution in May 2005 for monolateral blindness. In 1986, at the age of 53, she had been diagnosed elsewhere as having acromegaly based on clinical features, frankly elevated serum GH levels (ranging from 26.9 to 32 pg/l) and a computed tomography (CT) scan showing a hyperdense sellar lesion with suprasellar extension to the floor of the third ventricle. A bilateral impairment of visual field in the upper temporal area was documented. In 1987, the patient underwent transnasosphenoidal pituitary surgery with apparent complete excision of a macroadenoma and complete resolution of the visual field defect. Serum GH levels, however, remained elevated (7 yg/l) and responsive to TRH. In 1989, a hypothalamic-pituitary CT scan showed an empty sella, while the suprasellar expansion had completely disappeared. The injection of contrast medium disclosed, mostly in the right side of the sphenoid sinus, a lesion whose nature remained uncertain.
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