Liu Yang, Yang Jun
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Zhonghua Nan Ke Xue. 2020 Aug;26(8):736-739.
To present a case of Rathke's cleft cyst (RCC) in a middle-aged man complaining of depression and review the relevant literature.
A 51-year-old man firstly visited the outpatient clinic of neurology in our hospital due to 4 years of low mood. The patient was found normal in physical and thyroid function laboratory examinations and achieved a total score of 19 in Hamilton Depression Scale, which indicated depression. After failure to respond to antidepressant medication, the patient again came to the clinic of andrology and was found with sexual dysfunction and aspermia. With the serum FSH, LH, PRL, T and fasting blood glucose levels of 0.88 IU/L, 0.25 IU/L, 30.8 nmol/L, <0.24 nmol/L and 3.9 nmol/L respectively, it was considered to be a case of hypogonadotropic hypogonadism. Pituitary MRI indicated RCC but the adreno-cortico-tropic hormone and growth hormone were normal. All the data obtained led to the final diagnosis of RCC, acquired hypogonadotropic hypogonadism, depression and acquired aspermia and therefore the patient was referred to the department of neurosurgery and underwent navigation- and endoscopy-guided microsurgical resection of the Rathke cleft cyst via the nasopharynx and sella region in 2018.
RCC was pathologically confirmed postoperatively. At 3 months after surgery, the patient was found with a serum T level of 0.72 nmol/L and received the testosterone replacement therapy. After 3 months of treatment, the serum T was increased to 10.3 nmol/L, the patient's symptoms of depression, hyposexuality and sexual dysfunction were significantly improved, and a little semen was observed in the ejaculate.
RCC is one of causes of hypogonadism in middle-aged men, causing the clinical symptoms mainly by pressing the pituitary gland and inducing gonadotropin deficiency. It is hard for RCC patients with depression and sexual dysfunction to restore gonadotropin to normal even after surgical removal of the cyst and therefore testosterone replacement therapy is necessitated postoperatively.
报告一例主诉抑郁的中年男性拉克氏裂囊肿（RCC）病例，并复习相关文献。
一名51岁男性因4年情绪低落首次就诊于我院神经内科门诊。患者体格检查及甲状腺功能实验室检查均正常，汉密尔顿抑郁量表总分为19分，提示抑郁。抗抑郁药物治疗无效后，患者再次就诊于男科门诊，发现存在性功能障碍及无精子症。血清促卵泡生成素（FSH）、促黄体生成素（LH）、催乳素（PRL）、睾酮（T）及空腹血糖水平分别为0.88 IU/L、0.25 IU/L、30.8 nmol/L、<0.24 nmol/L及3.9 nmol/L，考虑为低促性腺激素性性腺功能减退。垂体磁共振成像（MRI）显示为RCC，但促肾上腺皮质激素及生长激素正常。所有检查结果最终诊断为RCC、后天性低促性腺激素性性腺功能减退、抑郁及后天性无精子症，因此患者于2018年被转诊至神经外科，行经鼻蝶窦区域导航及内镜引导下Rathke裂囊肿显微切除术。
术后病理证实为RCC。术后3个月，患者血清T水平为0.72 nmol/L，接受睾酮替代治疗。治疗3个月后，血清T升至10.3 nmol/L，患者的抑郁、性欲减退及性功能障碍症状明显改善，射精时可见少量精液。
RCC是中年男性性腺功能减退的原因之一，主要通过压迫垂体并导致促性腺激素缺乏引起临床症状。即使手术切除囊肿，合并抑郁及性功能障碍的RCC患者的促性腺激素也难以恢复正常，因此术后需要进行睾酮替代治疗。
