Rathke cleft cyst presenting with hyponatremia: an unusual presentation

Sivakumar, Walavan; Cole, Chad; Couldwell, William T.

doi:10.3171/2011.4.focus1180

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Two additional forms of endocrinopathy that were documented include stalk compression "hyperprolactinemia" 7,10,20,21 as well as severe hyponatremia, given that 2 patients in the series were diagnosed as a result of hyponatremia. 10,15,29,30 Visual Function Assessment. Preoperative and postoperative visual function assessment included visual acuity using the handheld eye card and formal visual field testing.…”

Section: Preoperative and Postoperative Evaluationmentioning

confidence: 99%

Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique

McLaughlin

Vandergrift

Filho

et al. 2012

JNS

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Sellar ACs can be effectively treated using endonasal fenestration and obliteration with fat with resultant reversal of presenting symptoms in the majority of patients. This simplified technique of AC cavity obliteration without enlarging communication to the SAS has a low risk of CSF leakage, and in most cases appears to effectively disrupt cyst progression, although longer follow-up is required to monitor for cyst recurrence.

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Section: Preoperative and Postoperative Evaluationmentioning

confidence: 99%

Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique

McLaughlin

Vandergrift

Filho

et al. 2012

JNS

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“…2 Various theories have been described in the published literature to explain the HN associated with RCC (►Table 1). [3][4][5][6][7][8][9] Hypocortisolemia as a Result of Chronic Inflammation of the Pituitary Gland Causing Hyponatremia Cortisol promotes sodium reabsorption and potassium excretion in the collecting tubules, which helps maintain plasma volume and serum sodium levels. In cases of hypocortisolemia, there can be a reduction in sodium reabsorption, leading to secondary HN.…”

Section: Discussionmentioning

confidence: 99%

“…RCC presenting with HN due to the syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported only a few times in the published literature (►Table 1). [3][4][5][6][7][8][9] SIADH is characterized by euvolemic HN, typically with low serum osmolality, increased urine osmolality, and high urine sodium concentration. Patients with SIADH often present with nonspecific symptoms, such as nausea, vomiting, headache, confusion, seizures, and muscle cramps, which can range from mild to severe depending on the degree of HN and its rate of development.…”

Section: Introductionmentioning

confidence: 99%

Unraveling the Mystery of Rathke's Cleft Cyst Presenting with Hyponatremia: A Case Report with a Comprehensive Review of Literature

Huda,

Singha,

Haidous

et al. 2024

Asian J Neurosurg

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Background Rathke's cleft cyst (RCC) is a benign cystic lesion that is commonly discovered incidentally and remains asymptomatic in most cases. However, its association with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion leading to hyponatremia (HN) is rare and has only been sporadically reported in the medical literature. In this article, we present a unique case of RCC manifesting with HN and discuss the diagnostic and management challenges encountered in a neurosurgical context. Additionally, we provide a comprehensive review of existing literature on RCC presenting with HN to enhance our understanding of this rare presentation. Case Description A 56-year-old woman with acute-onset blurry vision, headaches, and low fluid intake was diagnosed with euvolemic HN secondary to SIADH. Further evaluation revealed an intrasellar cystic lesion consistent with RCC, which was successfully resected through endoscopic transnasal transsphenoidal surgery, resulting in a complete recovery without the need for hormone replacement. Conclusion The most likely explanation for the HN due to SIADH in this case is the release of accumulated antidiuretic hormone (ADH) due to compression by the cyst and the irritating effect of inflammation at this location. Accurate evaluation and classification of HN are essential for proper diagnosis and management, considering the rarity of RCC presenting with HN. A multidisciplinary approach to treatment can lead to favorable functional outcomes; however, further research is necessary to better comprehend this unique clinical entity and optimize neurosurgical approaches.

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“…44 Although macroadenomas are mostly involved in such cases, 30,36,[45][46][47] patients with microadenomas 48 and ectopic adenomas 49 can also experience PA. Interestingly, an apoplectic event may complicate the course of lymphocytic inflammation in pituitary adenomas. 8,50 Metastatic tumors of the pituitary gland (such as small cell lung carcinoma, 51 prostatic adenocarcinoma, 52 endometrial adenocarcinoma, 53 renal cell carcinoma, 54 and hematologic malignancies) rarely cause PA. 9,41,[55][56][57] This syndrome may also occur in the setting of other space-occupying lesions of the sellar region including craniopharyngiomas, 58 Rathke's cleft cysts, [59][60][61][62] colloid cysts, 63 epidermoid cysts, 64 osteochondromas, 65 and tuberculomas. 66 In the absence of a pituitary tumor, PA can be caused by an acute infarction of the pituitary gland.…”

Section: Causes and Risk Factorsmentioning

confidence: 99%

Presenting Symptoms of Pituitary Apoplexy

Pyrgelis

Mavridis

Meliou

2017

J Neurol Surg A Cent Eur Neurosurg

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The classical term "pituitary apoplexy" (PA) describes a clinical syndrome usually characterized by abrupt onset of headache accompanied by neurologic and/or endocrinologic deterioration due to sudden expansion of a mass within the sella turcica as a result of hemorrhage or infarction within a pituitary tumor and adjacent pituitary gland. PA is a medical emergency and a difficult diagnosis to establish. Thus this article reviews the presenting symptoms of PA patients to help clinicians recognize or at least suspect this critical condition early on. PA commonly occurs in the setting of a preexisting adenoma, and several patients are unaware of its existence prior to the onset of apoplexy symptoms, which are mainly of a neurologic, ophthalmologic, and endocrinologic nature. Neurologic symptoms include sudden-onset severe headache and other symptoms of subarachnoid hemorrhage, symptoms from compression of the cavernous sinus contents, nausea/vomiting, impaired consciousness, and symptoms of meningeal irritation. Ophthalmologic symptoms include visual field defects, visual loss, diplopia, and ophthalmoplegia. Endocrinologic disturbances include pituitary adenoma symptoms, cortisol deficiency, panhypopituitarism, diabetes insipidus, and syndrome of inappropriate secretion of antidiuretic hormone. Magnetic resonance imaging is the imaging method of choice to aid the PA diagnosis. Its differential diagnoses include cerebrovascular accidents, infectious diseases, and other causes of endocrinologic imbalance. Transsphenoidal surgery is the treatment of choice, especially if there are associated visual abnormalities and ophthalmoplegia. Clinicians should be aware of the presenting symptoms because early diagnosis may reduce the morbidity and mortality of this neurosurgical emergency.

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Rathke cleft cyst presenting with hyponatremia: an unusual presentation

Cited by 8 publications

References 17 publications

Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique

Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique

Unraveling the Mystery of Rathke's Cleft Cyst Presenting with Hyponatremia: A Case Report with a Comprehensive Review of Literature

Presenting Symptoms of Pituitary Apoplexy

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