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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1788618
Case Report

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

Shayan Huda 
1   Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
2   CUNY School of Medicine, New York City, New York, United States
,
Souvik Singha 
1   Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Ali Haidous
1   Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Phillip R. Bukberg
3   Department of Endocrinology, Diabetes and Metabolism, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Bidyut K. Pramanik
4   Department of Radiology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Manju Harshan
5   Department of Pathology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Luis Medina Mora
3   Department of Endocrinology, Diabetes and Metabolism, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Maria Devita
6   Department of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Amy McKeown
1   Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
John A. Boockvar
1   Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
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Abstract

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.

Keywords

syndrome of inappropriate antidiuretic hormone secretion - Rathke's cleft cyst - hyponatremia - hypothalamic–pituitary axis - sellar–suprasellar lesion

Note

The study was conducted in accordance with the Declaration of Helsinki. The requirement for approval from the institutional review board was waived for this case report.


Authors' Contributions

S.H., S.S., P.R.B., and J.A.B. contributed conception or design, data acquisition, data analysis, data interpretation, drafting the work, and critical revision for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work. S.S. and J.A.B. also supervised the study A.H., B.K.P., M.H., L.M., and M.D. contributed to data acquisition, data analysis, data interpretation, drafting the work, and critical revision for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work. A.M. contributed to data acquisition, data interpretation, drafting the work, and critical revision for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.


Availability of Data and Material

Data will be made available to the editors of the journal for review or query upon request.




Publication History

Article published online:
30 July 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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