Central hypoadrenocorticism associated with Rathke's cleft cyst.

Area of Science:

• Endocrinology
• Neuroscience
• Pediatric Endocrinology

Background:

• Rathke's cleft cysts (RCCs) are benign cysts in the pituitary region, typically asymptomatic until middle age.
• The presentation and diagnosis of RCCs in pediatric and adolescent populations remain poorly understood.

Observation:

• An 18-year-old female presented with chronic morning fatigue since early teens.
• Brain MRI revealed characteristic signals of an RCC between the anterior and posterior pituitary glands.
• Endocrinological evaluation showed normal baseline adrenal function but a peculiar drop in serum cortisol around noon and suppressed ACTH secretion with hydrocortisone supplementation.

Findings:

• The observed pattern suggests central adrenal dysfunction secondary to the Rathke's cleft cyst.
• Literature review indicates that symptoms of hypothalamic-pituitary dysfunction can be non-specific and variable in adolescents.

Implications:

• This case highlights the importance of considering RCCs in the differential diagnosis of central adrenal dysfunction in adolescents.
• Brain MRI and daily cortisol profiling are crucial diagnostic tools for identifying impaired hypothalamic-adrenal function in this age group.
• Further research is needed to elucidate the long-term impact and prevalence of RCCs in pediatric populations.