Conservative Management of Symptomatic Rathke Cleft Cyst With Recurrent Inflammatory Remission

Rathke cleft cyst (RCC) is a benign, nonneoplastic cystic lesion arising from embryonic remnants of the Rathke pouch and is increasingly detected with the widespread use of brain magnetic resonance imaging (MRI). Most RCCs remain asymptomatic; however, some present with symptoms such as headaches, visual disturbances, or pituitary dysfunction, often attributed to inflammatory processes within the cyst wall. We report the case of a 68-year-old woman with a year-long history of intermittent headaches, polydipsia, and polyuria. Initial MRI revealed a cystic lesion in the sellar region, and endocrinological assessment confirmed arginine vasopressin deficiency. A serial MRI follow-up revealed recurrent, short-term fluctuations in cyst size, suggesting intermittent inflammatory activity within the RCC. Despite the option for surgical intervention, conservative management alone resulted in the resolution of her headaches and substantial cyst shrinkage. This case underscores the potential for conservative management in symptomatic RCCs with inflammatory features, where hormone replacement and careful imaging follow-up may suffice. It also highlights the need for individualized care and long-term monitoring, especially in cases with dynamic inflammatory behavior.