Natural history of Rathke's cleft cysts: A retrospective analysis of a two centres experience

Elisa Sala, Justin M. Moore, Alvaro Amorin, Giulia Carosi, Hector Martinez, Griffith R. Harsh, Maura Arosio, Giovanna Mantovani, Laurence Katznelson

Research output: Contribution to journalArticle

Abstract

Objective: Rathke's cleft cyst (RCC) is a common sellar lesion which may cause visual impairment, hypopituitarism and headaches from mass effect. The natural history of these lesions is currently unclear. We investigated the natural history of RCCs and compared surgically treated patients with those treated conservatively. Methods: We performed a retrospective cohort study of patients diagnosed with a RCC between 1996 and 2016 at Stanford University and Ospedale Maggiore Policlinico di Milano. Results: Patients were divided into 2 cohorts: Group A, 72 subjects who underwent surgical resection of a symptomatic RCC, and Group B, 62 subjects managed conservatively. Compared to Group B, Group A subjects had larger RCCs (79% vs 22% had a largest diameter >10 mm, P <.001) and were more likely (41.5% vs 16%, P <.001) to present with hypopituitarism and diabetes insipidus (DI) (18% vs 1.6%, P =.002). In Group A, after a mean follow-up of 53.7 months, 12.5% of patients had recurrence and a second surgery. After surgery, 35% of patients recovered pituitary function. Hyperprolactinemia (26.6%) and hypogonadism (66.6%) resolved more commonly that did DI (20.1%). New pituitary deficits appeared in 16.6% of patients after surgery. In Group B, with a mean follow-up of 41 months, only 6.4% had cyst enlargement, none underwent surgery, and none developed a pituitary deficit. Conclusion: Our data offer guidance in decision-making regarding the management of RCC patients and confirm the safety of conservative treatment in asymptomatic patients.

Original languageEnglish
Pages (from-to)178-186
Number of pages9
JournalClinical Endocrinology
Volume89
Issue number2
DOIs
Publication statusPublished - Aug 1 2018

Fingerprint

Central Nervous System Cysts
Hypopituitarism
Diabetes Insipidus
Natural History
Hyperprolactinemia
Hypogonadism
Vision Disorders
Patient Safety
Headache
Cysts
Decision Making
Cohort Studies
Retrospective Studies
Recurrence

Keywords

  • diabetes insipidus
  • hypopituitarism
  • neuroendocrinology
  • pituitary
  • pituitary tumour
  • Rathke's cleft cyst
  • transsphenoidal surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Sala, E., Moore, J. M., Amorin, A., Carosi, G., Martinez, H., Harsh, G. R., ... Katznelson, L. (2018). Natural history of Rathke's cleft cysts: A retrospective analysis of a two centres experience. Clinical Endocrinology, 89(2), 178-186. https://doi.org/10.1111/cen.13744

Natural history of Rathke's cleft cysts : A retrospective analysis of a two centres experience. / Sala, Elisa; Moore, Justin M.; Amorin, Alvaro; Carosi, Giulia; Martinez, Hector; Harsh, Griffith R.; Arosio, Maura; Mantovani, Giovanna; Katznelson, Laurence.

In: Clinical Endocrinology, Vol. 89, No. 2, 01.08.2018, p. 178-186.

Research output: Contribution to journalArticle

Sala, E, Moore, JM, Amorin, A, Carosi, G, Martinez, H, Harsh, GR, Arosio, M, Mantovani, G & Katznelson, L 2018, 'Natural history of Rathke's cleft cysts: A retrospective analysis of a two centres experience', Clinical Endocrinology, vol. 89, no. 2, pp. 178-186. https://doi.org/10.1111/cen.13744
Sala, Elisa ; Moore, Justin M. ; Amorin, Alvaro ; Carosi, Giulia ; Martinez, Hector ; Harsh, Griffith R. ; Arosio, Maura ; Mantovani, Giovanna ; Katznelson, Laurence. / Natural history of Rathke's cleft cysts : A retrospective analysis of a two centres experience. In: Clinical Endocrinology. 2018 ; Vol. 89, No. 2. pp. 178-186.
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abstract = "Objective: Rathke's cleft cyst (RCC) is a common sellar lesion which may cause visual impairment, hypopituitarism and headaches from mass effect. The natural history of these lesions is currently unclear. We investigated the natural history of RCCs and compared surgically treated patients with those treated conservatively. Methods: We performed a retrospective cohort study of patients diagnosed with a RCC between 1996 and 2016 at Stanford University and Ospedale Maggiore Policlinico di Milano. Results: Patients were divided into 2 cohorts: Group A, 72 subjects who underwent surgical resection of a symptomatic RCC, and Group B, 62 subjects managed conservatively. Compared to Group B, Group A subjects had larger RCCs (79{\%} vs 22{\%} had a largest diameter >10 mm, P <.001) and were more likely (41.5{\%} vs 16{\%}, P <.001) to present with hypopituitarism and diabetes insipidus (DI) (18{\%} vs 1.6{\%}, P =.002). In Group A, after a mean follow-up of 53.7 months, 12.5{\%} of patients had recurrence and a second surgery. After surgery, 35{\%} of patients recovered pituitary function. Hyperprolactinemia (26.6{\%}) and hypogonadism (66.6{\%}) resolved more commonly that did DI (20.1{\%}). New pituitary deficits appeared in 16.6{\%} of patients after surgery. In Group B, with a mean follow-up of 41 months, only 6.4{\%} had cyst enlargement, none underwent surgery, and none developed a pituitary deficit. Conclusion: Our data offer guidance in decision-making regarding the management of RCC patients and confirm the safety of conservative treatment in asymptomatic patients.",
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AU - Harsh, Griffith R.

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N2 - Objective: Rathke's cleft cyst (RCC) is a common sellar lesion which may cause visual impairment, hypopituitarism and headaches from mass effect. The natural history of these lesions is currently unclear. We investigated the natural history of RCCs and compared surgically treated patients with those treated conservatively. Methods: We performed a retrospective cohort study of patients diagnosed with a RCC between 1996 and 2016 at Stanford University and Ospedale Maggiore Policlinico di Milano. Results: Patients were divided into 2 cohorts: Group A, 72 subjects who underwent surgical resection of a symptomatic RCC, and Group B, 62 subjects managed conservatively. Compared to Group B, Group A subjects had larger RCCs (79% vs 22% had a largest diameter >10 mm, P <.001) and were more likely (41.5% vs 16%, P <.001) to present with hypopituitarism and diabetes insipidus (DI) (18% vs 1.6%, P =.002). In Group A, after a mean follow-up of 53.7 months, 12.5% of patients had recurrence and a second surgery. After surgery, 35% of patients recovered pituitary function. Hyperprolactinemia (26.6%) and hypogonadism (66.6%) resolved more commonly that did DI (20.1%). New pituitary deficits appeared in 16.6% of patients after surgery. In Group B, with a mean follow-up of 41 months, only 6.4% had cyst enlargement, none underwent surgery, and none developed a pituitary deficit. Conclusion: Our data offer guidance in decision-making regarding the management of RCC patients and confirm the safety of conservative treatment in asymptomatic patients.

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