A rare case report of panhypopituitarism and suspected pituitary apoplexy secondary to Rathke cleft cyst

Rathke cleft cysts are typically benign and asymptomatic lesions of the sellar region, with apoplexy and panhypopituitarism being uncommon presentations. We report the case of a 78-year-old male who presented with acute metabolic encephalopathy and panhypopituitarism secondary to a likely Rathke cleft cyst measuring less than 10 mm. Magnetic resonance imaging and clinical findings were consistent with a pituitary tumor, likely Rathke cleft cyst, causing suspected pituitary apoplexy, and subsequent panhypopituitarism, likely the cause of the patient's symptoms that developed and worsened over the next 6 months leading up to diagnosis. Despite the small cyst size, the patient developed central hypothyroidism, central adrenal insufficiency, and hypogonadism, all of which improved with hormone replacement therapy. The patient's improvement with medical management led to the decision not to pursue surgical intervention. Rathke cleft cyst apoplexy-inducing panhypopituitarism remains exceedingly rare; the largest published series identified only 21 confirmed cases over a decade-long period. This case highlights that even small Rathke cleft cysts can lead to significant endocrine dysfunction and underscores the need for vigilant follow-up.