Acromegaly Occurring In A Patient With A Pituitary Adenoma, Lymphocytic Hypophysitis, And A Rathke Cleft Cyst

ABSTRACT Objective: The concomitant presence of three histopathologically different lesions in the pituitary gland is a rare occurrence. We present a case of a woman with a large pituitary mass composed of a growth hormone–producing microadenoma, lymphocytic hypophysitis, and a Rathke cleft cyst. Methods: The clinical presentation, laboratory data, imaging studies, and pathology report of the patient's hospital course are described. Results: A 35-year-old woman presented with complaints of fever, persistent headaches, and amenorrhea for 1 year. The patient noted snoring, increase in shoe size, and bilateral hand edema for 3 months. Evaluation revealed a suprasellar mass measuring 2.1 × 1.7 × 2.7 cm with an upward mass effect on the optic chiasm. The physical exam revealed frontal bossing, wide-spaced teeth, prognathism, and sausage digits. Hormonal evaluation was consistent with acromegaly. She underwent a transsphenoidal resection of the lesion, and pathology revealed a growth hormone–producing microadenoma, lymphocytic hypophysitis, and a Rathke cleft cyst. Conclusion: Reports have identified the co-existence of ruptured Rathke cleft cysts with lymphocytic hypophysitis, the presence of Rathke cleft cyst with growth hormone–producing pituitary adenomas, and lymphocytic hypophysitis with growth hormone–producing adenomas. However, we are not aware of any reports of the presence of these three lesions in a single pituitary. Abbreviations: IGF-1 = insulin-like growth factor 1; MRI = magnetic resonance imaging