Endocrine Abstracts

Introduction: The most common sellar and suprasellar lesions are pituitary adenomas, craniopharyngiomas and benign cysts. Rathke’s cleft cyst (RCC) is a benign developmental sellar or suprasellar cystic lesion, which is rarely symptomatic.Case HistoryWe present the case history of 21-year-old woman with a suprasellar RCC, causing early optic chiasmal compression and associated with hyperprolactinemia. Past medical history included neurofibromatosis type 1 (NF1), optic glioma and right-sided cerebellar cystic lesions. There was bilateral ptosis, learning difficulties and precocious puberty. Our patient presented with sudden onset of headache and left-sided visual blurring. There was no history of galactorrhoea and periods were regular. Visual fields were normal and there was no papilledema. Cafe-au-lait spots were noted on the trunk. Pituitary hormone profile revealed elevated prolactin 1191mu/l (normal range, 0-450), TSH 1.89mu/l (0.30-5.50), FSH 3.6u/l, LH 4.6u/l and somatomedin C 22.4nmol/l (13.4-62.1). Short synacthen test was normal. Visual fields and ocular coherence tomography was normal. MRI pituitary revealed an enlarged pituitary gland measuring 1.3 x 1.2 x 1.1 cm. There was suprasellar extension and in the superior portion of the gland there was a 6 mm diameter rounded hypo-enhancing lesion causing early optic chiasmal compression. Our patient was reviewed by the pituitary surgeon who felt that surgical intervention was not needed. We initiated cabergoline (500mg once weekly) and this caused the prolactin levels to normalise. Repeat MRI pituitary scan did not reveal any interval change in size or appearance of the well-defined superiorly located pituitary lesion with suprasellar extension. As in the previous MRI, there was early optic chiasm compression.ConclusionIt is important to consider RCC in the differential diagnosis of sellar and suprasellar cystic lesions. RCC may occur with pituitary adenomas but an association with NF1 has not been previously reported.