A Case of Rathke's Cleft Cyst with Panhypopituitarism

Abstract

A 41-year-old man was admitted to our hospital because of general fatigue, sexual debility and finger stiffness. Endocrinological examinations revealed that he had panhypopituitarism, resulting in secondary adrenal insufficiency, hypothyroidism and gonadal failure. Computed tomography (CT) of the head demonstrated a low density intrasellar mass, while brain magnetic resonance imaging (MRI) showed a high intensity mass extending from the intrasellar to suprasellar region in both T1WI and T2WI. The mass was removed by transsphenoidal surgery and histologically diagnosed as Rathke's cleft cyst. Replacement with hydrocortisone and levothyroxine sodium greatly improved the clinical symptoms. Rathke's cleft cyst causing panhypopituitarism is relatively rare. The clinical and endocrinological characteristics of Rathke's cleft cyst were discussed based on the findings in 49 Japanese cases including this case and two other cases we have experienced.

Panhypopituitarism due to Rathke's Cleft Cyst Associated with Pituitary Oncocytoma.

“…However, in this review (21) and another by Eguchi et al (5), only 2 of 23 and 2 of 19 patients had evidence ofpanhypopituitarism associated with Rathke's cleft cyst. Accordingly, panhypopituitarism in patients with Rathke's cleft cyst is not common.In our patient, six hormones of the anterior pituitary were disturbed to a greater or lesser degree.…”

“…In areview of Japanese patients with Rathke's cleft cyst (21 ), some degree of hypopituitarism was found in 19 out of 23 patients, indicating that pituitary dysfunction is more common in patients with Rathke's cleft cyst than previously reported.…”