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 language | English |
|---|---|
| Pages (from-to) | 178-186 |
| Number of pages | 9 |
| Journal | Clinical Endocrinology |
| Volume | 89 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Aug 1 2018 |
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Keywords
- diabetes insipidus
- hypopituitarism
- neuroendocrinology
- pituitary
- pituitary tumour
- Rathke's cleft cyst
- transsphenoidal surgery
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
Cite this
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 journal › Article
}
TY - JOUR
T1 - Natural history of Rathke's cleft cysts
T2 - A retrospective analysis of a two centres experience
AU - Sala, Elisa
AU - Moore, Justin M.
AU - Amorin, Alvaro
AU - Carosi, Giulia
AU - Martinez, Hector
AU - Harsh, Griffith R.
AU - Arosio, Maura
AU - Mantovani, Giovanna
AU - Katznelson, Laurence
PY - 2018/8/1
Y1 - 2018/8/1
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.
AB - 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.
KW - diabetes insipidus
KW - hypopituitarism
KW - neuroendocrinology
KW - pituitary
KW - pituitary tumour
KW - Rathke's cleft cyst
KW - transsphenoidal surgery
UR - http://www.scopus.com/inward/record.url?scp=85050121919&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050121919&partnerID=8YFLogxK
U2 - 10.1111/cen.13744
DO - 10.1111/cen.13744
M3 - Article
AN - SCOPUS:85050121919
VL - 89
SP - 178
EP - 186
JO - Clinical Endocrinology
JF - Clinical Endocrinology
SN - 0300-0664
IS - 2
ER -