Rathke cleft cyst - with a fluid-fluid level

Case contributed by Dr Chris O'Donnell

Presentation

Elevated prolactin. Headache with no visual disturbance, ? pituitary adenoma.

Patient Data

Age: 40
Gender: Male

Cystic mass in the pituitary with a fluid/fluid level on the axial scan (arrow). Peripheral enhancement is the normal gland being compressed by the cyst, not the cyst wall. On T2 coronal there is lower signal intensity sediment and in the higher signal supernatant there is a "dot sign" (arrow), seen commonly in Rathke cysts

Case Discussion

Fluid/fluid levels in Rathke cysts are uncommon but well recognised. It might be due to recent haemorrhage but can also be a feature of proteinaceous debris within the cyst fluid.

Elevated prolactin is not due to the cyst excreting prolactin, rather a mass that compresses the pituitary stalk can lead to interruption of dopamine flow from the hypothalamus through the hypophyseal-portal circulation to the anterior pituitary. Unlike other hypothalamic control of the pituitary, control of prolactin secretion is primarily inhibitory.

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Case information

rID: 34005
Case created: 1st Feb 2015
Last edited: 21st Nov 2015
Inclusion in quiz mode: Included

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