Endocrine Abstracts

JOINT3408

Introduction: Rathke’s cleft cysts (RCC) are frequent benign cystic sellar lesions (13 - 22%). Most RCC are small, intrasellar and asymptomatic. Larger cysts may compress adjacent structures and rarely become symptomatic. We report the case of hypopituitarism revealing a RCC.

Observation: A 74-year-old hypertensive menopausal patient, followed for rheumatoid arthritis and treated with corticosteroids, presented at our endocrinology department with recurrent hypoglycaemia, chronic headaches and visual disturbances. On clinical examination, visual field abnormalities are found. Hormonal testing showed basal cortisol level at 17ng/ml confirming corticotropic, thyrotropic, gonadotropic insufficiencies with a normal prolactin level at 17ng/ml. A hypothalamic-pituitary MRI revealed a cystic lesion occupying the sella turcica, measuring 27mm, with a pure liquid signal that was unmodified by gadolinium injection, displacing the optic chiasm and posterior pituitary. Therefore, the diagnosis of RCC complicated with hypopituitarism and visual compression was made and the patient was started on hydrocortisone 15mg/day and levothyroxine 75µg/day, with a follow-up MRI to monitor the cyst’s long-term progression.

Conclusions: The vast majority of Rathke’s pouch cysts remain small, asymptomatic, and are often discovered incidentally. Only about 1% to 5% of Rathke’s pouch cysts become symptomatic, typically when they enlarge and compress nearby structures such as the optic chiasm or pituitary gland. This makes symptomatic Rathke’s pouch cysts relatively rare, with their occurrence being significantly lower than that of asymptomatic cases.