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.

SUBJECTS AND 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: R Trifanescu, V Stavrinides, P Plaha, S Cudlip, J V Byrne, O Ansorge, J A H Wass, N Karavitaki
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 165 Issue 1 Pg. 33-7 (Jul 2011) ISSN: 1479-683X [Electronic] England
• PMID: 21502327 (Publication Type: Journal Article)

Chemical References

• Adrenocorticotropic Hormone
• Luteinizing Hormone
• Follicle Stimulating Hormone
• Thyrotropin
• Deamino Arginine Vasopressin

Topics

• Adenoma (complications, surgery)
• Adolescent
• Adrenocorticotropic Hormone (deficiency)
• Adult
• Aged
• Aged, 80 and over
• Central Nervous System Cysts (complications, surgery)
• Child
• Deamino Arginine Vasopressin (therapeutic use)
• Diabetes Insipidus (etiology)
• Female
• Follicle Stimulating Hormone (deficiency)
• Humans
• Luteinizing Hormone (deficiency)
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Pituitary Neoplasms (surgery)
• Thyrotropin (deficiency)
• Treatment Outcome
• Visual Fields