Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexy
Complicated Rathke’s cleft cyst (RCC) is a rare occurrence of symptomatic bleeding or growth of a previously asymptomatic (and often undiagnosed) intrasellar cyst derived from remnants of Rathke’s pouch, situated on the midline between the adeno- and neurohypophysis. Symptoms may be identical to tho...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Bioscientifica
2022-08-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM21-0214.xml |
| _version_ | 1818491184294658048 |
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| author | S M Constantinescu G Wilms R M Furnica T Duprez D Maiter |
| author_facet | S M Constantinescu G Wilms R M Furnica T Duprez D Maiter |
| author_sort | S M Constantinescu |
| collection | DOAJ |
| description | Complicated Rathke’s cleft cyst (RCC) is a rare occurrence of symptomatic bleeding or growth of a previously asymptomatic (and often undiagnosed) intrasellar cyst derived from remnants of Rathke’s pouch, situated on the midline between the adeno- and neurohypophysis. Symptoms may be identical to those of pituitary apoplexy: acute onset of headache, hypopituitarism, and neurological disturbances. Both syndromes may also exhibit a similar appearance of a large haemorrhagic sellar mass at initial radiological evaluation. We report on two patients who presented with headache and complete hypopituitarism. Based on the initial MRI, they were first diagnosed with pituitary apoplexy but managed conservatively with hormone therapy alone because of the absence of severe visual or neurological threat. Upon follow-up at 4 months, clinical evolution was good in both patients but their pituitary mass had not reduced in size and, after careful radiologic reviewing, was more indicative of a large midline complicated RCC. In conclusion, the diagnosis of complicated RCC is challenging because it can mimic pituitary apoplexy clinically, biologically, and radiologically. Clinicians should distinguish between the two entities using specific radiological signs or evolution of the mass at MRI if the patient does not undergo surgery. To our knowledge, we report conservative management of this rare condition for the first time, though it seems appropriate in the absence of neurological compromise or visual compression. Long-term follow-up is however mandatory. |
| first_indexed | 2024-12-10T17:27:21Z |
| format | Article |
| id | doaj.art-210cd893e27744fe858bd8e9b5520a48 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 |
| language | English |
| last_indexed | 2024-12-10T17:27:21Z |
| publishDate | 2022-08-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-210cd893e27744fe858bd8e9b5520a482022-12-22T01:39:48ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732022-08-01111610.1530/EDM-21-0214Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexyS M Constantinescu0G Wilms1R M Furnica2T Duprez3D Maiter4Department of EndocrinologyDepartment of Radiology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of EndocrinologyDepartment of Radiology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of EndocrinologyComplicated Rathke’s cleft cyst (RCC) is a rare occurrence of symptomatic bleeding or growth of a previously asymptomatic (and often undiagnosed) intrasellar cyst derived from remnants of Rathke’s pouch, situated on the midline between the adeno- and neurohypophysis. Symptoms may be identical to those of pituitary apoplexy: acute onset of headache, hypopituitarism, and neurological disturbances. Both syndromes may also exhibit a similar appearance of a large haemorrhagic sellar mass at initial radiological evaluation. We report on two patients who presented with headache and complete hypopituitarism. Based on the initial MRI, they were first diagnosed with pituitary apoplexy but managed conservatively with hormone therapy alone because of the absence of severe visual or neurological threat. Upon follow-up at 4 months, clinical evolution was good in both patients but their pituitary mass had not reduced in size and, after careful radiologic reviewing, was more indicative of a large midline complicated RCC. In conclusion, the diagnosis of complicated RCC is challenging because it can mimic pituitary apoplexy clinically, biologically, and radiologically. Clinicians should distinguish between the two entities using specific radiological signs or evolution of the mass at MRI if the patient does not undergo surgery. To our knowledge, we report conservative management of this rare condition for the first time, though it seems appropriate in the absence of neurological compromise or visual compression. Long-term follow-up is however mandatory.https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM21-0214.xml |
| spellingShingle | S M Constantinescu G Wilms R M Furnica T Duprez D Maiter Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexy Endocrinology, Diabetes & Metabolism Case Reports |
| title | Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexy |
| title_full | Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexy |
| title_fullStr | Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexy |
| title_full_unstemmed | Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexy |
| title_short | Conservative management of complicated Rathke’s cleft cyst mimicking pituitary apoplexy |
| title_sort | conservative management of complicated rathke s cleft cyst mimicking pituitary apoplexy |
| url | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM21-0214.xml |
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