ECE2023 Eposter Presentations Pituitary and Neuroendocrinology (234 abstracts)
1Basaksehir Cam and Sakura City Hospital, Endocrinology and Metabolic Diseases, Turkey; 2Neurosurgery, Basaksehir Cam and Sakura City Hospital, Neurosurgery, Turkey; 3Basaksehir Cam and Sakura City Hospital, Neurosurgery, Turkey; 4Basaksehir Cam and Sakura City Hospital, Radiology, Turkey; 5Basaksehir Cam and Sakura City Hospital, Pathology, Turkey.
Introductıon: Rathkes cleft cysts (RCCs) are benign lesions originating from the epithelial remnants of Rathkes pouch with a peak incidence at 3050 years of age. It is detected at a rate of 1333% 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 (0.274.2 mlU/ml), T4: 0.5 ng/dl (0.931.70 ng/dl), kortizol: 2, ACTH:13 pg/ml (7.263.3 pg/ml), FSH: 1 mlU/ml (1.112.4 mlU/ml), LH:1.1 mlU/ml (1.78.6 mlU/ml), total testosterone: <0.025 ng/ml (2.88) Prolactin: 2.72 ng/ml (415 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. Rathkes cleft cysts originate from epithelial cells of the developing Rathkes 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 Rathkes 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.