MISLEADING DIAGNOSIS OF SECONDARY ADRENAL INSUFFICIENCY IN A THAI PATIENT WITH RATHKE’S CLEFT CYST

A DIAGNOSTIC CHALLENGE IN PITUITARY INCIDENTALOMA

Authors

  • Waralee Chatchomchuan
  • Yotsapon Thewjitcharoen
  • Sirinate Krittiyawong
  • Soontaree Nakasatien
  • Thep Himathongkam

Keywords:

secondary adrenal insufficiency, Rathke’s cleft cyst, insomnia, stress, pituitary mass

Abstract

CASE
Rathke's cleft cysts (RCCs) are common sellar/suprasellar tumors with variable clinical presentations. We report a 56-year-old Thai male who initially received an incorrect diagnosis of secondary adrenal insufficiency despite presenting with weight loss and low basal serum cortisol. The patient complained of 8 kg weight loss, insomnia, and decreased sexual desire. Morning cortisol was 3.7 µg/dL. The patient had a prior diagnosis of adrenal insufficiency. At our hospital, serum cortisol was 3.0 µg/dL., ACTH was 10.3 pg/mL and other pituitary hormones were normal. The pituitary MRI revealed a small pituitary lesion consistent with Rathke's cleft cyst. ACTH stimulation test confirmed normal adrenal function. Psychological treatment for insomnia was initiated, and the patient improved without steroids. Follow-up tests remained unremarkable. It is crucial to conduct thorough clinical assessments and hormonal tests to avoid erroneous diagnoses of symptomatic Rathke's cleft cysts in patients with reduced basal cortisol levels

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Author Biographies

Waralee Chatchomchuan

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Yotsapon Thewjitcharoen

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Sirinate Krittiyawong

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Soontaree Nakasatien

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Thep Himathongkam

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

References

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Published

2023-11-09

How to Cite

Chatchomchuan, W., Thewjitcharoen, Y., Krittiyawong, S. ., Nakasatien, S. ., & Himathongkam, T. . (2023). MISLEADING DIAGNOSIS OF SECONDARY ADRENAL INSUFFICIENCY IN A THAI PATIENT WITH RATHKE’S CLEFT CYST: A DIAGNOSTIC CHALLENGE IN PITUITARY INCIDENTALOMA. Journal of the ASEAN Federation of Endocrine Societies, 38(S3), 88. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/3457

Issue

Vol. 38 No. S3 (2023): AFES Book of Abstracts (Supplement)

Section

Poster Presentation | Pituitary

License

Copyright (c) 2023 Waralee Chatchomchuan, Yotsapon Thewjitcharoen, Sirinate Krittiyawong, Soontaree Nakasatien, Thep Himathongkam

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