A Case for Conservative Management: Characterizing the Natural History of Radiographically Diagnosed Rathke Cleft Cysts

Abstract

The increasingly prevalent use of brain imaging modalities such as MRI has resulted in an increase in the incidental discovery of pituitary lesions. Our study demonstrates that the majority of radiologically diagnosed RCCs remain unchanged or decrease in size over time. These results suggest that, in the absence of pressure symptoms, it is reasonable to manage patients with RCCs conservatively.

Natural history of Rathke's cleft cysts: A retrospective analysis of a two centres experience

“…Of note, GHD was defined in this study by basal GH levels, which are not recommended for diagnosis. Similar to other reports, we found that the most frequently reported hormone abnormalities were hypogonadism and hyperprolactinemia . Interestingly, while cyst size and extension were similar to those in other studies (Aho et al 62%, Raper 75%, Shin 100%), we detected a higher prevalence of pituitary deficits.…”

“…We can confirm prior findings that a conservative approach is safe in most patients with RCC less than 10 mm in diameter. Our study is the first to demonstrate that, in RCC patients who did not undergo surgery, pituitary function remained stable, with some patients even improving, during follow‐up . Impressively, hyperprolactinemia resolved in 50% of patients during follow‐up.…”

“…Reported hypopituitarism in the setting of RCC has varied between 0% and 81% of patients . Of note, many studies have not described how hypopituitarism was defined, which may explain the disparate prevalence rates.…”

“…The prevalence of RCC ranges from 11% to 20% in autopsy studies, and most are discovered incidentally. They are more common in adults, with a peak incidence at 30‐50 years . In symptomatic cases, the cyst may cause headache, visual impairment and/or hypopituitarism.…”

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

“…Yet, based on the current literature, this approach is not necessarily unjustified since it is unclear whether pituitary microadenomas can cause pituitary deficiency, e.g., through a mass effect on adjacent normal tissue. Pediatric endocrinologists should review any questionable images with the radiologist including asking if the lesions are consistent with a pars intermedia/Rathke cleft cyst, a common lesion that rarely grows in size or causes symptoms [18, 19]. …”