Endocrine Abstracts

Introductıon: Rathke’s cleft cysts (RCCs) are benign lesions originating from the epithelial remnants of Rathke’s pouch with a peak incidence at 30–50 years of age. It is detected at a rate of 13–33% in several autopsy series. RCC is usually asymptomatic and diagnosed incidentally. In symptomatic cases, common symptoms are headache, visual disturbance, and symptoms related to hypopituitarism.

Case: A 28-year-old male patient presented a three-year history of headaches, severe weakness, impotence, and decreased libido. The patient had no polyuria or polydipsia. Physical examination was unremarkable. Laboratory data revealed panhypopituitarism. TSH: 0.01 mlU/ml (0.27–4.2 mlU/ml), T4: 0.5 ng/dl (0.93–1.70 ng/dl), kortizol: 2, ACTH:13 pg/ml (7.2–63.3 pg/ml), FSH: 1 mlU/ml (1.1–12.4 mlU/ml), LH:1.1 mlU/ml (1.7–8.6 mlU/ml), total testosterone: <0.025 ng/ml (2.8–8) Prolactin: 2.72 ng/ml (4–15 ng/ml). MRI showed a cystic tumor in the sellar region, with a largest diameter of 11 mm. Replacement treatment with levothyroxine, hydrocortisone, and testosterone was initiated, and surgery was recommended because of panhypopituitarism. He underwent transsphenoidal surgery. His pathology is Rathke cleft cyst, and focal nonproliferative salivary gland glandular structures adjacent to these areas are observed.

Discussion: Pituitary development begins in the 3rd and 4th weeks of the fetal period. The anterior lobe (adenohypophysis) is derived from oral ectoderm and is epithelial in origin, whereas the posterior lobe (neurohypophysis) derives from the neural ectoderm. Rathke’s cleft cysts originate from epithelial cells of the developing Rathke’s pouch. It can be explained by the migration of seromucous glands located in the primitive oral cavity into the Rathke pouch. Salivary gland (SG) tissue may occur in different sites. Intrasellar ectopic SG rests are typically localized close to the neurohypophysis or in the pars intermedia, often communicating with the Rathke’s cleft, and maybe incidentally found at autopsy. Only a small group of people is noticeable because of mass effects and endocrine dysfunction, particularly hyperprolactinemia, as the current literature is limited to case reports.