Issue Navigator

Volume 13 No. 11
Earn CME
Accepted Papers

Case Reports

Non-24-Hour Sleep-Wake Rhythm Disorder and Melatonin Secretion Impairment in a Patient With Pineal Cyst

Lorenzo Ferri, MD1; Marco Filardi, PhD1; Monica Moresco, MSc1; Fabio Pizza, MD, PhD1,2; Stefano Vandi, RPSGT1; Elena Antelmi, MD1,2; Francesco Toni, MD3; Mino Zucchelli, MD4; Giulia Pierangeli, MD, PhD1,2; Giuseppe Plazzi, MD, PhD1,2
1DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; 2IRCCS Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy; 3IRCCS Institute of Neurological Science of Bologna, Division of Neuroradiology, Bellaria Hospital, Bologna, Italy; 4IRCCS Institute of Neurological Science Bologna, Pediatric Neurosurgery, Bellaria Hospital, Bologna, Italy

We report the case of a 14-year-old girl with a wide non-compressive pineal cyst, associated with the inability to control her sleep-wake schedule. Actigraphic monitoring showed a 24-hour free-running disorder (tau 26.96 hours). A 24-hour serum melatonin curve assay, with concomitant video-polysomnographic and body-core temperature monitoring, was performed. Melatonin curve showed a blunted nocturnal peak, lower total quantity of melatonin, and prolonged melatonin secretion in the morning, with normal temperature profile and sleep parameters. Treatment with melatonin up to 14 mg at bedtime was initiated with complete realignment of the sleep-wake rhythm (tau 23.93 hours). The role of the pineal cyst in the aforementioned alteration of melatonin secretion and free-running disorder remains controversial, but our case supports the utility of monitoring sleep/wake, temperature, and melatonin rhythms in the diagnostic work-up of pineal cysts associated with free-running disorder.


Ferri L, Filardi M, Moresco M, Pizza F, Vandi S, Antelmi E, Toni F, Zucchelli M, Pierangeli G, Plazzi G. Non-24-hour sleep-wake rhythm disorder and melatonin secretion impairment in a patient with pineal cyst. J Clin Sleep Med. 2017;13(11):1355–1357.

Supplemental Material

Login to view supplemental material

Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership

Subscribe to JCSM:  $75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.

Download this article*:   $20 to access a PDF version of a specific article from the current issue of JCSM.

*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.