Endocrine Abstracts

Introduction: The most common sellar lesions are mainly due to pituitary adenomas, craniopharyngiomas and benign cysts. Rathke’s cleft cyst (RCC) is a developmental sellar or suprasellar cystic lesion, which rarely becomes symptomatic. Here, we present an interesting case of intra sellar RCC, with a presenting feature of acute pituitary apoplexy.

Case report: A 39 year old healthy women was referred to the emergency room for sudden headache and fatigue without visual disturbance. Neurological examination was within normal limits and brain CT scan revealed a high density 9 mm area in the sella suggesting a pituitary apoplexy. The patient was hospitalized and treated with hydrocortison infusion. Hormonal profile was within normal limits indicating normal pituitary function. On MRI study, oval slightly hyperintense areas measuring 10-mm were noted on T1 weighted that turned hypointense on T2 weighted sequence. The same lesions were seen in pituitary MRI realized 5 years ago showing stability of the mass which highly suggested the diagnosis of RCC.

Conclusion: RCCs are rarely symptomatic. CT and MRI brain studies are essential in establishing the diagnosis In the presence of apoplectic symptoms. However, it is important to include RCC in addition to pituitary apoplexy in the differential diagnosis.