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Summary: A 42-year-old man had a severe progressive headache and visual field defects due to pituitary apoplexy. Transsphenoidal resection of a pituitary tumor (measuring approximately 8.7 cm3) resulted in the complete relief of his symptoms. Histological examination revealed the presence of a pituitary adenoma and an inverted papilloma of the sphenoid sinus.This communication emphasizes the following: (1) mucosal thickening and an inverted papilloma of the sphenoid sinus can be a precipitating factor in pituitary apoplexy; (2) an inverted papilloma of the sphenoid sinus may increase intrasellar pressure and therefore increase the risk of acute pituitary apoplexy; (3) if imaging shows thickening of the sphenoid sinus mucosa, then a partial resection of the sphenoid sinus mucosa for histological evaluation should be performed during the transsphenoidal resection of the pituitary tumor. [ABSTRACT FROM AUTHOR]