Endocrine Abstracts

Introduction: Rathke’s cleft cyst is one of the pituitary non-adenomatous tumors that found in about 20% of pituitary glands at autopsy. Symptomatic Rathke’s cleft cysts are rarely, but these cysts can cause serious medical problems associated with compression of the pituitary gland, pituitary stalk, optic nerve or hypothalamus. Here, we report a rare case of 73 years old man with sudden onset headache due to Rathke’s cleft cyst present with symptoms and radiological features like apoplexy of pituitary adenoma.

Case: A 73-year-old man admitted to our hospital with weight loss and sudden onset headache. His body mass index were 31.8 kg/m², blood pressure: 120/84 mmHg and 68 per min with a regular rhythm. Neurologic examination was normal. Laboratory findings were as follows: CBC was normal, Serum sodium: 138 mmol/l, potassium: 4.8 mmol/l, urea nitrogen: 35 mg/dl, creatinine: 1.1 mg/dl, fasting plasma glucose: 102 mg/dl, hemoglobin A1c: 7.3%. Anterior pituitary function tests were as follows: morning serum cortisol 0.99 μg/dl, Adrenocorticotrophic hormone (ACTH) 14.2 pg/ml, free T3 1.82 μg/dl, free T4 1.32 μg/dl, thyroid stimulating hormone (TSH) 2.36 mIU/ml, luteinizing hormone (LH) 1.18 mIU/ml, follicle stimulating hormone (FSH) 2.47 mIU/ml, serum testosterone <0.0025 ng/dl and serum prolactin of 12 ng/ml. His laboratory tests revealed panhypopituitarism. Brain magnetic resonance imaging (MRI) showed a 20×15 cm sized sellar cystic lesion, which consisted of a Rathke’s cleft cyst. On the basis of these results, supplementation with thyroid hormone and glucocorticoid was started. After 1 month of supplementation treatment control MRI showed a 8.7×4.3 cm Rathke’s cleft cyst which was regressed compared to initial imaging.

Conclusion: The neurologic symptoms of endocrinopathies can be associated with Rathke’s cleft cyst and hemorrhagic pituitary adenoma. The radiological evaluation can be spurious in these patients. Longer follow-up must be needed in order to confirm the exact diagnosis.