Abstract
We report the case of a 29-yr-old woman who first presented an aseptic meningitis at the beginning of a pregnancy. She was admitted one month later with headaches and vomiting. Panhypopituitarism with diabetes insipidus was diagnosed. Magnetic resonance imaging (MRI) data suggested the existence of lymphocytic infundibulohypophysitis, with inflammation of the suprasellar area. No new symptoms were noticed until 6 months later when this patient pointed out troubles of the visual field, due to a compression of the optic chiasma. Three boluses of 1 g methylprednisolone were prescribed, with no effects. After delivery, the defects of the visual field increased. A neurosurgical intervention was decided. Diagnosis of Rathke’s cleft cyst (RCC) was made. We concluded that this patient presented a rupture of a RCC, which occurred at the beginning of pregnancy, associated later with panhypopituitarism with diabetes insipidus, due to a probable hypophysitis. The end of the pregnancy was marked by consequences of an increased volume of the RCC. To our knowledge, this case is the first described during pregnancy.
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Teramoto A, Hirakawa K, Sanno N, Osamura Y. Incidental pituitary lesions in 1000 unselected autopsy specimens. Radiology 1994, 193: 161–4.
Voelker JL, Campbell RL, Muller J. Clinical, radiographic, and pathological features of symptomatic Rathke’s cleft cysts. J Neurosurg 1991, 74: 535–44.
Albini CH, MacGillivray MH, Fisher JE, Voorhess ML, Klein DM. Triad of hypopituitarism, granulomatous hypophysitis, and ruptured Rathke’s cleft cyst. Neurosurgery 1988, 22: 133–6.
Daikokuya H, Inoue Y, Nemoto Y, Tashiro T, Shakudo M, Ohata K. Rathke’s cleft cyst associated with hypophysitis: MRI. Neuroradiology 2000, 42: 532–4.
Macaulay RJB. Ruptured Rathke’s cleft cyst: a possible cause of Tolosa-Hunt syndrome. Clin Neuropathol 1997, 16: 98–102.
Roncaroli F, Bacci A, Frank G, Clabucci F. Granulomatous hypophysitis caused by a ruptured intrasellar Rathke’s cleft cyst: report of a case and review of the litterature. Neurosurgery 1998, 43: 146–9.
Sumida M, Uozumi T, Mukada K, Arita K, Kurisu K, Eguchi K. Rathke cleft cysts: correlation of enhanced MR and surgical findings. AJNR Am J Neuroradiol 1994, 15: 525–32.
Wearne MJ, Barber PC, Johnson AP. Symptomatic Rathke’s cleft cyst with hypophysitis. Br J Neurosurg 1995, 9: 799–03.
Leung GK, Lopes MB, Thorner MO, Vance ML, Laws ER Jr. Primary hypophysitis: a single-center experience in 16 cases. J Neurosurg 2004, 101: 262–71.
Bellastella A, Bizzarro A, Coronella C, Bellastella G, Sinisi AA, De Bellis A. Lymphocytic hypophysitis: a rare or underestimated disease? Eur J Endocrinol 2003, 149: 363–76.
Del Pozo JM, Roda JE, Montoya JG, Iglesias JR, Hurtado A. Intrasellar granuloma. Case report. J Neurosurg 1980, 53: 717–9.
Honegger J, Fahlbusch R, Bornemann A, et al. Lymphocytic and granulomatous hypophysitis: experience with nine cases. Neurosurgery 1997, 40: 713–22.
Hama S, Arita K, Nishisaka T, et al. Changes in the epithelium of Rathke cleft cyst associated with inflammation. J Neurosurg 2002, 96: 209–16.
Hama S, Arita K, Tominaga A, et al. Symptomatic Rathke’s cleft cyst coexisting with central diabetes insipid us and hypophysitis: case report. Endocrine J 1999, 46: 187–92.
Benveniste RJ, King WA, Walsh J, Lee JS, Naidich TP, Post KD. Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg 2004, 101: 577–84.
Kim JE, Kim JH, Kim OL, etal. Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg 2004, 100: 33–40.
Mukherjee JJ, Islam N, Kaltsas G, et al. Clinical, radiological and pathologicalfeatures of patients with Rathke’s cleft cysts: tumors that may recur. J Clin Endocrinol Metab 1997, 82: 2357–62.
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Sonnet, E., Roudaut, N., Mériot, P. et al. Hypophysitis associated with a ruptured Rathke’s cleft cyst in a woman, during pregnancy. J Endocrinol Invest 29, 353–357 (2006). https://doi.org/10.1007/BF03344108
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DOI: https://doi.org/10.1007/BF03344108