Rathke's cleft cyst

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Rathke's cleft cyst
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Rathke's cleft cyst in a 53-year-old man with a pituitary adenoma and acromegaly

A Rathke's cleft cyst is a benign growth on the pituitary gland in the brain, specifically a mucin-filled [1] cyst in the posterior portion of the anterior pituitary gland. [2] [3] It occurs when the Rathke's pouch does not develop properly and ranges in size from 2 to 40 mm in diameter. [3]

Asymptomatic cysts are commonly detected during autopsies in 2 to 26 percent of individuals who have died of unrelated causes. Females are twice as likely as males to develop a cyst. [3] If a cyst adds pressure to the optic chiasm, it may cause visual disturbances, pituitary dysfunction and headaches. [2] The majority of pituitary patients with chronic headaches have Rathke's cleft cysts. This is believed to be caused by the constant change in volume and the drastic changes in vasopressure from fluctuations in gonadotrophs and ADH. [4]

The treatment of choice for symptomatic cysts is drainage and taking a biopsy. [5] [6] Radical excision is more dangerous because of the potential of damaging the patient's pituitary function e.g. ADH storage and lowering growth hormone production.[ citation needed ]

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A prolactinoma is a benign tumor (adenoma) of the pituitary gland that produces a hormone called prolactin. It is the most common type of functioning pituitary tumor. Symptoms of prolactinoma are due to too much prolactin in the blood (hyperprolactinemia), or those caused by pressure of the tumor on surrounding tissues. Based on size, a prolactinoma can be classified as a microprolactinoma or a macroprolactinoma.

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Craniopharyngioma Medical condition

A craniopharyngioma is a rare type of brain tumor derived from pituitary gland embryonic tissue that occurs most commonly in children, but also affects adults. It may present at any age, even in the prenatal and neonatal periods, but peak incidence rates are childhood-onset at 5–14 years and adult-onset at 50–74 years. People may present with bitemporal inferior quadrantanopia leading to bitemporal hemianopsia, as the tumor may compress the optic chiasm. It has a point prevalence around two per 1,000,000. Craniopharyngiomas are distinct from Rathke's cleft tumours and intrasellar arachnoid cysts.

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Empty sella syndrome Medical condition

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Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

Shona Holmes, or Shona Robertson-Holmes, is a Canadian woman who underwent treatment for a Rathke's cleft cyst in the United States, and claimed the condition threatened her life. Her cyst was removed August 1, 2005. Holmes sought treatment in the US claiming that she was unable to get timely treatment in Canada. Holmes sued the Ontario provincial government seeking payment for her medical and travel expenses. She has given testimony before members of the US Congress during a Republican-sponsored hearing about healthcare legislation, and has appeared in ads seeking to repeal the Patient Protection and Affordable Care Act and defeat President Obama in the 2012 presidential election.

Galactorrhea hyperprolactinemia is increased blood prolactin levels associated with galactorrhea. It may be caused by such things as certain medications, pituitary disorders and thyroid disorders. The condition can occur in males as well as females. Relatively common etiologies include prolactinoma, medication effect, kidney failure, granulomatous diseases of the pituitary gland, and disorders which interfere with the hypothalamic inhibition of prolactin release. Ectopic (non-pituitary) production of prolactin may also occur. Galactorrhea hyperprolactinemia is listed as a “rare disease” by the Office of Rare Diseases of the National Institutes of Health. This means that it affects less than 200,000 people in the United States population.

Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors in the anterior skull base. Normally an otolaryngologist performs the initial stage of surgery through the nasal cavity and sphenoid bone; a neurosurgeon performs the rest of the surgery involving drilling into any cavities containing a neural organ such as the pituitary gland. The use of endoscope was first introduced in Transsphenoidal Pituitary Surgery by R Jankowsky, J Auque, C Simon et al. in 1992 G.

References

  1. Abdelzaher, E. Rathke cleft cyst. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cnstumorrathkecyst.html. Accessed May 26th, 2018.
  2. 1 2 "Rathke's Cleft Cyst". UCLA. Archived from the original on 2010-07-07. Retrieved 2009-07-27.
  3. 1 2 3 Omar Islam (2008-05-28). "Rathke Cleft Cyst: Overview". Web MD. Archived from the original on 2009-08-27. Retrieved 2015-05-10.
  4. Arman Jahangiri; Jeffrey R. Wagner; Aaron T. Chin; Sung Won Han; Mai T. Tran; Liane M. Miller; Maxwell W. Tom; Rebecca Chen; Sandeep Kunwar; Lewis Blevins; Manish K. Aghi (2015), "Incidence of headache as a presenting complaint in over 1,000 patients with sellar lesions and factors predicting postoperative improvement", Clinical Neurology and Neurosurgery, 132 (May 2015): 16–20, doi:10.1016/j.clineuro.2015.02.006, PMID   25746316
  5. Omar Islam (2008-05-28). "Rathke Cleft Cyst: Follow-up". Web MD. Archived from the original on 2010-01-31.
  6. Marcella Koch; Benjamin White; Kar-Ming Fung (2004-03-02). "A 45-year-old man with a sellar mass". Department of Pathology, University of Oklahoma Health Sciences Center. Archived from the original on 2009-02-20. Retrieved 2015-05-10.