Transient cerebrospinal fluid rhinorrhea, blurred vision, and headache as presenting symptoms of pituitary adenoma.

Case Report A 40-year-old man requested a routine physical examination at his family physician's office. He had been in good health throughout his life but mentioned an unusual occurrence during a commercial airline flight 6 weeks prior to the visit. Soon after takeoff he noticed clear fluid that looked like tears draining from his left nostril. When he blew his nose to clear the drainage, he developed blurred vision in his left eye and a moderate headache. The blurred vision made it difficult to read a magazine but was not accompanied by scotoma or obvious loss of peripheral vision. He asked the flight attendant for two aspirin and took a nap for 1 hour. Upon awakening, the headache had resolved. The blurred vision was slightly better and returned to normal within an hour. One week later the patient gently blew his nose and had similar blurring of his vision that lasted only 10 minutes. After that episode, he did not experience nasal drainage, headache, or blurred vision, but he consciously avoided blowing his nose. Findings of initial physical and neurologic examinations were normal, including visual field confrontation testing, visual acuity testing, and funduscopic examination. No nasal drainage was noted. The lateral view of a sinus radiograph series showed enlargement of the sella turcica with loss of the anterior portion of the floor of the