Image Legend
A 21-year-old-woman presented with a 1-month history of headaches. Head computed tomography (CT) and magnetic resonance imaging (MRI) revealed acute sphenoid sinusitis (*, panels E and F), likely causing her headaches. Gadolinium-enhanced MRI also showed a right 7-mm pituitary lesion (arrowheads) with poor contrast enhancement on T1-weighted images (panels A and D), presumed as a pituitary adenoma (PA), and a separate 8-mm lesion anterior to the stalk (arrows) with low-intensity on T1 (panels A and D) and high-intensity on T2-weighted images with an intracystic nodule (panels B and C), compatible with Rathke cleft cyst (RCC). She had regular menstrual cycles, no polydipsia or polyuria, and her pituitary function and serum prolactin were normal. Headaches resolved following sinusitis-directed treatment. RCCs can be found in 13% to 22% of normal pituitaries, but rarely coexist with PAs. Concomitant RCC and PA often occurs on MRI evaluation for PA patients, or following surgery for a PA [1, 2]. However, it is unusual to encounter a RCC and a presumed nonfunctioning PA incidentally found in a patient investigated for headaches, none causing this presenting manifestation. This case also alerts for the need of considering other etiologies for headaches in patients with small RCCs and/or nonfunctioning PAs to prevent inadequate management.
Abbreviations
- CT
computed tomography
- MRI
magnetic resonance imaging
- PA
pituitary adenoma
- RCC
Rathke cleft cyst
Contributor Information
Pedro Marques, Endocrinology Department, Pituitary Tumor Unit, Hospital CUF Descobertas, Lisbon 1998-018, Portugal; Faculty of Medicine, Universidade Católica Portuguesa, Rio de Mouro, Lisbon 2635-631, Portugal.
Lia Neto, Radiology Department, Pituitary Tumor Unit, Hospital CUF Descobertas, Lisbon 1998-018, Portugal.
Inês Sapinho, Endocrinology Department, Pituitary Tumor Unit, Hospital CUF Descobertas, Lisbon 1998-018, Portugal.
Amets Sagarribay, Neurosurgery Department, Pituitary Tumor Unit, Hospital CUF Descobertas, Lisbon 1998-018, Portugal.
Funding
No public or commercial funding.
Disclosures
The authors have nothing to disclose.
Informed Patient Consent for Publication
Signed informed consent was obtained directly from the patient.
Data Availability Statement
Original data generated and analyzed for this case report are included in this published article.
References
- 1. Sumida M, Migita K, Tominaga A, Iida K, Kurisu K. Concomitant pituitary adenoma and Rathke's cleft cyst. Neuroradiology. 2001;43(9):755‐759. [DOI] [PubMed] [Google Scholar]
- 2. Wu W, Jia G, Jia W, Li G, Zhang J, Zhang L. Pituitary adenoma associated with Rathke's cleft cyst: report of 15 cases. Can J Neurol Sci. 2018;45(1):68‐75. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Original data generated and analyzed for this case report are included in this published article.