Symptomatic Rathke's cleft cysts: a report of 24 cases.
We review the clinical, hormonal and imaging features of 24 consecutive patients with symptomatic Rathke's cleft cysts (RCCs), and assess the long-term effectiveness and complications of transsphenoidal cyst removal. Out of 250 consecutive patients, 24 (10%) underwent endonasal transsphenoidal surgery for RCC; 19 (79%) were women. Symptoms at presentation included headaches (83%), hyperprolactinemia (38%), central hypothyroidism (21%), galactorrhea (13%), diabetes insipidus (13%), IGF-1 deficiency (13%), central adrenal insufficiency (8%) and visual loss (8%). In total, 37% of women had irregular menses and 60% of men sexual dysfunction and hypogonadism. Two girls presented with precocious puberty. Cyst size varied from 7 to 25 mm. Fifteen (60%) had a suprasellar component. Initial and 3-month post-operative imaging revealed complete cyst resection in 23 of 24 patients. Headaches resolved in 65% of subjects and visual loss resolved in both patients who presented with this symptom. Of those presenting with endocrinopathy, 56% had improvement of at least one anterior pituitary axis; two subjects (8%), both with suprasellar RCC, developed a new hormone deficiency post-operatively and two sujects young girls, (8%) had RCC recurrence, one at 36 months after surgery, requiring a second operation, and the other had a small asymptomatic recurrence 6 months after surgery. In conclusion, RCC accounts for 10 % of surgically treated sellar and suprasellar masses. Headache, hyperprolactinemia, menstrual irregularities and sexual dysfunction are common presenting symptoms. Simple cyst removal via a transsphenoidal approach offers a safe and effective treatment. Cyst recurrence may be more common in children.
Cohan
P
P
Division of Endocrinology, University of California School of Medicine, Los Angeles, California, USA. pcohan@mednet.ucla.edu
Foulad
A
A
Esposito
F
F
Martin
N A
NA
Kelly
D F
DF
D000293:Adolescent; D000328:Adult; D020863:Central Nervous System Cysts / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D006966:Hyperprolactinemia / Q000209:etiology; D008297:Male; D008599:Menstruation Disturbances / Q000209:etiology; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D016896:Treatment Outcome