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Case Reports in Endocrinology
Volume 2014 (2014), Article ID 693294, 6 pages
http://dx.doi.org/10.1155/2014/693294
Case Report

A Case of Rathke’s Cleft Cyst Associated with Transient Central Adrenal Insufficiency and Masked Diabetes Insipidus

1Department of Endocrinology and Metabolism, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo 102-0071, Japan
2Department of Endocrinology and Metabolism, Tokyo Kyosai Hospital, 2-3-8, Nakameguro, Meguro-ku, Tokyo 153-0061, Japan
3Department of Pathology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-0001, Japan
4Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
5Institute of Biochemical Research and Innovation Hospital, 2-2 Minatoshima-Minamicho, Chuo-ku, Kobe, Hyogo 650-0047, Japan

Received 23 August 2014; Revised 18 October 2014; Accepted 20 October 2014; Published 6 November 2014

Academic Editor: Osamu Isozaki

Copyright © 2014 Masahiro Asakawa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 73-year-old woman admitted to our hospital because of headache, poor appetite, malaise, weight loss, and vomiting was found to have central adrenal insufficiency and thyrotoxicosis due to silent thyroiditis. Polyuria developed after replacement with glucocorticoid (masked diabetes insipidus), which was controlled with nasal administration of desmopressin. Magnetic resonance imaging of the brain showed a large cystic pituitary mass (18 × 18 × 12 mm) extending suprasellarly to the optic chiasm. Transsphenoidal surgery revealed that the pituitary tumor was Rathke’s cleft cyst. Following surgery, replacement with neither glucocorticoid nor desmopressin was needed any more. Therefore, it is suggested that Rathke’s cleft cyst is responsible for the masked diabetes insipidus and the central insufficiency. Furthermore, it is speculated that thyrotoxicosis with painless thyroiditis might induce changes from subclinical adrenal insufficiency to transiently overt insufficiency.