Premature menopause secondary to Rathke’s pouch cyst (2013)

<p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">A 35 year old female presented with 6 years of amenorrhoea with a background history of menstrual irregularity preceding the amenorrhoea. She was treated as polycystic ovarian syndrome (PCOS) but finally found to have a very large pituitary lesion. This was originally thought to be a non-functioning pituitary adenoma, however intraoperative findings suggest the lesion was likely a Rathke’s cleft cyst, a relatively rare sellar mass whose hormonal effects were secondary to compression of normal pituitary tissue. Interestingly despite definitive resection and stabilisation of lactotrophs and gonadotroph levels our patient continued to have hypogondotrophic hypogonadism and finally required a hysterectomy for the safe initiation of HRT.</span></span></span> <p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow-BoldOblique,sans-serif;"><span style="font-size: x-small;"><em><strong>Background: </strong></em></span></span></span><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">Pituitary pathology accounts for 19% of secondary amenorrhoea. Because menstrual disturbances are a large part of the workload in gynaecology it is important for gynaecologists to have an understanding of pituitary aetiologies for amenorrhoea. As well as secondary amenorrhoea, pituitary pathologies can also mimic other gynaecological conditions such as polycystic ovarian syndrome and primary ovarian failure. It is important to consider the pituitary gland as a cause.</span></span></span> <p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">Gynaecologists are in a good position to recognise the presentation of many pituitary lesions. Approximately 1 in 3 pituitary adenomas are prolactinomas, making it the most common form of pituitary adenoma. High serum prolactin presents with subfertility, oligomenorrhoea or amenorrhoea, and interestingly, least commonly with galactorrhoea. Many of these symptoms would promote a referral to gynaecology. Other pituitary lesions can also present with these same symptoms purely by mass effect and compression of the pituitary stalk. Stalk compression causes decreased negative feedback by dopamine on prolactin production leading to hyperprolactinaemia. Therefore, the most common presentation of pituitary macroadenomas, both hormone secreting and non-functioning, are also menstrual and fertility dysfunction.</span></span></span> <p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">The mass effect caused by pituitary lesions is not limited to pituitary adenomas. Rarer lesions include craniopharyngiomas, meningiomas, malignant tumours, hypophsitis and Rathke's cleft cysts. The case I would like to put forward is of particular interest as our case study was found to have a large pituitary lesion which was thought to be a Rathke's cleft cyst, a relatively rare sellar mass, whose hormonal effects were all secondary to compression of normal pituitary tissue. Interestingly despite resection of the lesion our patient continued to have amenorrhea secondary to pituitary tissue damage. She illustrates the strong link between gynaecological symptoms and pituitary and sellar pathology, and is a rare and interesting learning case.</span></span></span> <p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">DOI: <a href="http://dx.doi.org/10.4038/sljog.v35i2.6163">http://dx.doi.org/10.4038/sljog.v35i2.6163</a></span></span></span> <p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow-Bold,sans-serif;"><span style="font-size: x-small;"><em><span style="font-weight: normal;">Sri Lanka Journal of Obstetrics and Gynaecology</span></em><strong> </strong><span style="font-family: Helvetica-Narrow,sans-serif;">2013; 35: 65-66</span></span></span></span>