Secondary SUNCT Syndrome in a Patient with Rathke’s Cleft Cyst and Hyperprolactinemia: a Case Report

Abstract

Pathophysiology of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) remains unclear. SUNCT is considered the primary type of a headache, but several cases of secondary SUNCT syndrome were described in patients with pituitary neoplasms, mainly pituitary micro- and macroadenomas. Rathke’s cleft cyst is a suprasellar noncancerous cystic lesion. We described a new case of SUNCT in a patient with Rathke’s cleft cyst with persistent hyperprolactinemia at the beginning of the headaches. After beginning of treatment with antiepileptic drugs (topiramate 75 mg/day, followed by replacement lamotrigine 75 mg/day), the headaches regressed. Also, cabergoline 0.5 mg was added to the therapy, 1 time a week; after 4 months, the level of prolactin was normalized, after beginning of dopamine agonists. After discontinuation of all treatments, after 4 months, the patient again began to develop daily single headaches, clinically similar to those that were at the onset of the disease, against the background of an increase in blood prolactin levels. Against the background of normalization of prolactin level, the headaches disappeared. We assume that in this case, the main reason for the secondary SUNCT was an influence of anatomical structures and caused neuroendocrine changes in the hypothalamus-pituitary system, but there are still discussions about what mechanism is the main reason for SUNCT. Therefore, clinicians should also pay attention to the history of symptoms associated with tumors in the pituitary gland and perform magnetic resonance imaging of the brain, pituitary gland, and screening for hormonal disorders in the blood serum.