Invasive pituitary adenomas with infrasellar extension can present with epistaxis and nasal obstruction, mimicking nasopharyngeal carcinoma (NPC) and leading to misdiagnosis. A 32‑year‑old male was initially misdiagnosed with NPC and received chemoradiotherapy. Multidisciplinary assessment revealed an invasive sellar mass, prolactin >2,000 ng/mL, and PIT‑1 positivity, establishing a diagnosis of invasive prolactinoma. Bromocriptine induced significant tumor reduction but was complicated by cerebrospinal fluid (CSF) leakage and intracranial infection. Surgical resection and leak repair led to favorable recovery with normalized prolactin levels. This case highlights the need for routine hormonal screening, nasopharyngeal mucosal integrity assessment, and multidisciplinary collaboration.
