Endocrine Abstracts

Objective: Rathke’s Cleft Cyst (RCC) is a common incidental type of sellar lesion, and, depending on size, may cause local mass effects with visual impairment, hypopituitarism, and headaches. In this study, we sought to define the natural history of RCC.

Methods: We performed a retrospective study of patients diagnosed with RCC between 2000 and 2016 at Stanford University Hospital, US, and Ospedale Maggiore Policlinico di Milano, Italy. Aim of the study is to investigate tumor size and pituitary function in adult patients with RCC who underwent surgery vs conservative monitoring.

Results: Patients were divided into: Group A, 72 subjects who underwent surgical resection of symptomatic RCC; and Group B, 62 subjects who did not undergo surgery and underwent serial monitoring. Compared to Group B, Group A subjects had more RCC > 10 mm (79% vs 22%, P < 0.001); supra and extrasellar extension in 72% vs 33%, P< 0.001, hypopituitarism in 41.5% vs 16%, P< 0.001; and diabetes insipidus (DI) in 18 and 1.6% P=0.002, respectively. The presence of hyperprolactinemia was similar between groups (18 vs 16%). In Group A, after a mean follow up of 53.7 months, 12.5% of patients had recurrence and underwent a second surgical procedure. Surgery resulted in recovery of pituitary function in 35% of patients. Hyperprolactinemia (26.6%) and hypogonadism (66.6%) were the most common axes that recovered after surgery. Prevalence of diabetes insipidus (20.1%) did not change significantly after surgery. In addition, 16.6% of patients experienced a new pituitary deficit after surgery. In Group B, the majority of patients had stable RCC dimension with a mean follow up of 41 months: 6.4% had cyst enlargement, without need of surgical intervention. After a mean hormonal follow up of 37.2 months, no patients in Group B developed a new pituitary deficit.

Conclusion: We evaluated the natural history of RCC in subjects who underwent surgery for symptomatic RCC vs those who had conservative monitoring. Following surgery, the majority of patients had stable remission as well as improvement in endocrine function over the 3 years follow up. In addition, subjects who are followed conservatively remained stable with regard to tumor size and hormone function. Our data offer important context in decision making about follow up of RCC patients, confirming the safety of non-surgical treatment in asymptomatic patients.