title: Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed.
abstract: OBJECTIVE
  To clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.
  
  
  METHODS
  The records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.
  
  
  RESULTS
  A total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2-267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3-48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.
  
  
  CONCLUSIONS
  In this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.
authors.affiliation: Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK.
authors.forename: R
authors.initials: R
authors.lastname: Trifanescu
authors.forename: V
authors.initials: V
authors.lastname: Stavrinides
authors.forename: P
authors.initials: P
authors.lastname: Plaha
authors.forename: S
authors.initials: S
authors.lastname: Cudlip
authors.forename: J V
authors.initials: JV
authors.lastname: Byrne
authors.forename: O
authors.initials: O
authors.lastname: Ansorge
authors.forename: J A H
authors.initials: JA
authors.lastname: Wass
authors.forename: N
authors.initials: N
authors.lastname: Karavitaki
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000172:deficiency; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020863:Central Nervous System Cysts / Q000150:complications / Q000601:surgery*; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D005640:Follicle Stimulating Hormone / Q000172:deficiency; D006801:Humans; D007986:Luteinizing Hormone / Q000172:deficiency; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010911:Pituitary Neoplasms / Q000601:surgery*; D013972:Thyrotropin / Q000172:deficiency; D016896:Treatment Outcome; D014794:Visual Fields
chemical_list: D000324:Adrenocorticotropic Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin; D003894:Deamino Arginine Vasopressin