# Rathke Cleft Cyst Presenting as Panhypopituitarism in an Adolescent

## TL;DR

A rare case of a Rathke cleft cyst causing hormone deficiencies in a teenage boy is reported, showing improvement with hormone therapy.

## Contribution

This paper presents a rare pediatric case of Rathke cleft cyst causing panhypopituitarism and demonstrates successful hormone replacement therapy.

## Key findings

- A 16-year-old male with short stature and delayed puberty was found to have a Rathke cleft cyst causing multiple hormone deficiencies.
- Hormone replacement therapy led to a 6-cm height increase and mild cyst regression over 12 months.
- Hormone therapy is suggested as a first-line treatment for RCC-associated hypopituitarism without neurological symptoms.

## Abstract

Rathke cleft cyst (RCC) is a benign lesion of the pituitary region, more commonly diagnosed in adults, in whom it typically presents with headaches, visual disturbances, or endocrine dysfunction. In pediatric patients, RCC is rare and even less frequently associated with panhypopituitarism. We report a case of a 16-year-old male patient who presented with short stature and delayed puberty. Hormonal evaluation revealed deficiencies in cortisol, thyroid hormone, gonadotropins, testosterone, and growth hormone. Magnetic resonance imaging (MRI) of the pituitary showed a 10 × 12.5 × 11.3-mm RCC displacing the pituitary stalk. Hormone replacement therapy with hydrocortisone, levothyroxine, and growth hormone was initiated. After 12 months, the patient showed a 6-cm increase in height and mild regression of cyst size. This case highlights the importance of considering RCC in the differential diagnosis of adolescents with growth failure or delayed puberty, even in the absence of typical symptoms such as headache or visual impairment. Hormone replacement therapy can be a safe and effective first-line treatment for RCC-associated hypopituitarism in the absence of severe neurological symptoms. Surgery should be reserved for cases with substantial headache or vision-related complications. Regular clinical and radiological follow-up is essential to monitor hormonal function and cyst progression.