From headache to Rathke’s cleft cyst followed by diabetes insipidus with panhypopituitarism

ABSTRACT Introduction The Rathke cyst represents an unusual benign tumour derived from Rathke’s cleft remnants. The diagnosis is potential seen at any age. The most frequent signs are mostly mass effects as headache, visual field defects and hypopituitarism. Case presentation 30-year old female is admitted for persistent headache that was later associated with secondary amenorrhea and visual field defects for the last two years. The clinical data are consistent with high levels of serum prolactin, gonadotropes deficiency, as well as central hypothyroidism. The magnetic resonance imagery found a pituitary tumour of 2.7 centimetres with extrapituitary extension up to the optic chiasm. Surgery was performed in order to remove the tumour. The pathologic report confirmed a Rathke’s cleft cyst. Diabetes insipidus associated with panhypopituitarism was diagnosed and treated after the procedure. Close follow-up is necessary. Conclusion This case highlights the fact that headache sometimes embraces a severe neoplasia diagnosis and that the iatrogenic complications after surgery are lifelong care demanding

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Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed

Acta Endocrinologica ◽

10.1530/eje-11-0142 ◽

2011 ◽

Vol 165 (1) ◽

pp. 33-37 ◽

Cited By ~ 18

Author(s):

R Trifanescu ◽

V Stavrinides ◽

P Plaha ◽

S Cudlip ◽

J V Byrne ◽

...

Keyword(s):

Visual Field ◽

Visual Field Defects ◽

Rathke's Cleft Cysts ◽

Long Term Monitoring ◽

Rathke's Cleft ◽

Term Monitoring ◽

Field Defects ◽

Tsh Deficiency

ObjectiveTo clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.Subjects and methodsThe records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.ResultsA total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2–267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3–48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.ConclusionsIn this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.

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Pituitary metastasis in breast cancer: case report and literature review

10.21203/rs.3.rs-17071/v1 ◽

2020 ◽

Author(s):

Xiaosong Sha ◽

Xiejun Zhang ◽

Lei Chen ◽

Jihu Yang ◽

Guodong Huang

Keyword(s):

Breast Cancer ◽

Visual Field ◽

Diabetes Insipidus ◽

Diagnostic Methods ◽

Electrolyte Imbalance ◽

Visual Field Defects ◽

Nerve Paralysis ◽

Loss Of Vision ◽

Field Defects ◽

Pituitary Metastasis

Abstract Background: Breast cancer commonly metastasizes to the lung, vertebrae or liver but rarely to the pituitary gland. The majority of cases have been reported during autopsy; however, with the improvements in diagnostic methods, there has been an increasing number of cases reported in the clinical setting. The main symptoms of pituitary metastasis are reported to be headache, diabetes insipidus and visual field defects, which may cause confusion regarding the clinical diagnosis.Case presentation: The present study describes a case of pituitary metastasis symptoms of diabetes insipidus and loss of vision in a patient with breast cancer. After the patient completed the evaluation, a neuroendoscopy-assisted endonasal transsphenoidal tumor resection was performed. The postoperative biopsy revealed metastatic breast cancer.Conclusions: The present study analyzed this patient and 16 other cases of pituitary metastases collected from the PubMed database. Lung cancer, breast cancer and lymphoma could metastasize to the sellar region, while certain other tumors from the liver, parotid, colon, prostate, stomach, kidney, thyroid or skin were also observed. The clinical manifestation was often dominated by pituitary dysfunction, intracranial hypertension and visual field defects. Certain patients may suffer from oculomotor nerve paralysis, electrolyte imbalance, diabetes insipidus or a loss of vision. Imaging findings revealed that sellar metastases often invaded the suprasellar region. In a few cases, the lesion enclosed intracranial vessels, and invaded the cavernous sinus or Meckel's cave. These characteristics resulted in difficulties during surgery.

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Symptomatic Rathke's Cleft Cyst Coexisting with Central Diabetes Insipidus and Hypophysitis: Case Report.

Endocrine Journal ◽

10.1507/endocrj.46.187 ◽

1999 ◽

Vol 46 (1) ◽

pp. 187-192 ◽

Cited By ~ 44

Author(s):

SEIJI HAMA ◽

KAZUNORI ARITA ◽

ATSUSHI TOMINAGA ◽

MASAMI YOSHIKAWA ◽

KUNIKI EGUCHI ◽

...

Keyword(s):

Case Report ◽

Diabetes Insipidus ◽

Central Diabetes Insipidus ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Rathke's Cleft

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A Case of Rathke’s Cleft Cyst Associated with Transient Central Adrenal Insufficiency and Masked Diabetes Insipidus

Case Reports in Endocrinology ◽

10.1155/2014/693294 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Masahiro Asakawa ◽

Rina Chin ◽

Yoshihiro Niitsu ◽

Tetsuo Sekine ◽

Arisa Niwa ◽

...

Keyword(s):

Diabetes Insipidus ◽

Adrenal Insufficiency ◽

Optic Chiasm ◽

Nasal Administration ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Pituitary Mass ◽

Silent Thyroiditis ◽

Central Adrenal Insufficiency ◽

Rathke's Cleft

A 73-year-old woman admitted to our hospital because of headache, poor appetite, malaise, weight loss, and vomiting was found to have central adrenal insufficiency and thyrotoxicosis due to silent thyroiditis. Polyuria developed after replacement with glucocorticoid (masked diabetes insipidus), which was controlled with nasal administration of desmopressin. Magnetic resonance imaging of the brain showed a large cystic pituitary mass (18 × 18 × 12 mm) extending suprasellarly to the optic chiasm. Transsphenoidal surgery revealed that the pituitary tumor was Rathke’s cleft cyst. Following surgery, replacement with neither glucocorticoid nor desmopressin was needed any more. Therefore, it is suggested that Rathke’s cleft cyst is responsible for the masked diabetes insipidus and the central insufficiency. Furthermore, it is speculated that thyrotoxicosis with painless thyroiditis might induce changes from subclinical adrenal insufficiency to transiently overt insufficiency.

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