High prevalence of adrenal insufficiency at diagnosis and headache recovery in surgically resected Rathke’s cleft cysts—a large retrospective single center study

Langlois, Fabienne; Manea, Anamaria; Lim, Dawn Shao Ting; McCartney, Shirley; Yedinak, Christine G.; Cetas, Justin S.; Fleseriu, Maria

doi:10.1007/s12020-018-1784-0

Cited by 16 publications

(9 citation statements)

References 38 publications

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“…Simply explained by the triggered inflammatory reaction occurring secondary to cyst rupture, this co-existence was previously reported in other cases of both lymphocytic and xantho-granulomatous hypophysitis [17,18]. Adrenal insufficiency was reported to be common in patients with Rathke's cleft cysts [19]; however, only one out of three of our cases had adrenal hormone deficiency. Although we performed IgG4 immunostaining in available pathology specimens, it was not achievable to fully evaluate patients regarding IgG4-related hypophysitis due to the retrospective nature of our study.…”

Section: Total N Preliminary Diagnosis (N %) 20supporting

confidence: 74%

Clinical Characteristics, Management, and Treatment Outcomes of Primary Hypophysitis: A Monocentric Cohort

et al. 2020

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Primary hypophysitis (PH) is a rare autoimmune inflammatory disease of the pituitary gland. The aim of the study was to evaluate clinical characteristics, disease management, and outcomes of cases with PH. Medical records of PH patients admitted to Hacettepe University Hospital between 1999 and 2017 were analyzed retrospectively. Paraffin-embedded pathology blocks were obtained for both re-examination and IgG4 immunostaining. Twenty PH patients (15 females, 5 males) were evaluated. Mean age at diagnosis was 41.5±13.4 years. Some form of hormonal disorder was present in 63.2% of cases, hypogonadism (66.6%) being the most common. Panhypopituitarism was present in 36.8%. All patients had pituitary gland enlargement on magnetic resonance imaging; stalk thickening and loss of neurohypophyseal bright spot were present in 17.6 and 23.5%, respectively. Lymphocytic hypophysitis was the most common histopathological subtype (50%). Among pathology specimens available for IgG and IgG4 immunostaining (n=10), none fulfilled the criteria for IgG4-related hypophysitis. Four patients were given glucocorticoid treatment in diverse protocols; as initial therapy in 3. Sixteen cases underwent surgery, 7 of whom due to neuro-ophthalmologic involvement. Only 1 patient was observed without any intervention. Reduction of pituitary enlargement was seen in all surgical and glucocorticoid treated cases. None of the surgical patients showed hormonal improvement while one case in glucocorticoid group improved. PH should be considered in the differential diagnosis of sellar masses causing hormonal deficiencies. MRI findings are usually helpful, but not yet sufficient for definitive diagnosis of PH. Treatment usually improves symptoms and reduces sellar masses while hormonal recovery is less common.

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Section: Total N Preliminary Diagnosis (N %) 20supporting

confidence: 74%

Clinical Characteristics, Management, and Treatment Outcomes of Primary Hypophysitis: A Monocentric Cohort

et al. 2020

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“…Nishioka et al underline that visual disturbances correlate with the cyst size [36]. Therefore, we assume that the lower frequency of visual impairment in our study is at least partially attributable to the lower median cyst dimension compared to other studies, which report the diameter between 10 and 20 mm [5,10,16,18,31,32,36,38,39]. In most series the percentage of cysts exceeding 10 mm is over 50% [18,26,28,32] while in our cohort it accounted for 36%.…”

Section: Discussionmentioning

confidence: 37%

“…Rathke cleft cysts (RCC) are non-malignant cystic lesions considered to be the most common incidental finding of the sellar and suprasellar region [1,2]. They are detected in up to 15% of surgical pituitary cases and in up to 11% of unselected autopsies [2][3][4][5]. A recent extensive Polish retrospective study of over 2300 patients operated due to intrasellar mass revealed RCC in less than 1% of cases [6].…”

Section: Introductionmentioning

confidence: 99%

Presenting symptoms and endocrine dysfunction in Rathke cleft cysts — a two-centre experience

Dadej

Skraba

Matyjaszek‐Matuszek

et al. 2021

Endokrynologia Polska

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Introduction: Rathke cleft cysts (RCC) arise as developmental abnormalities of the pituitary gland and are usually diagnosed incidentally. However, they may present with headaches, visual impairment, or pituitary dysfunction. Rathke cleft cysts are poorly described in the Polish literature. We aimed to characterize presenting symptoms, associated endocrine dysfunction, and concomitant disorders in the Polish population of patients with RCC. Material and methods: We performed a retrospective analysis of medical records of 102 patients diagnosed with RCC between 2006 and 2021 at Heliodor Swiecicki Clinical Hospital in Poznan and Independent Public Clinical Hospital No. 4 in Lublin. Results:The cohort was 72% female, with a mean age of 43 years. The median maximal cyst diameter was 7 mm. The majority of subjects were overweight or obese and presented lipid profile or glucose disturbances. Common presenting symptoms included headache, vertigo, and visual impairment. Less frequently we observed sexual dysfunction, irregular menses, galactorrhoea, or fatigue. Hormonal abnormalities were identified in 30% of patients, with hyperprolactinaemia being the commonest endocrinopathy (23%). Pituitary function in patients with RCC did not correlate with cyst size. Both concomitant pituitary adenomas and pineal cysts were diagnosed in 3% of patients. A considerable proportion of subjects were diagnosed with Hashimoto's thyroiditis and multinodular goitre. Conclusions: RCCs occur mostly in females and may result in a variety of symptoms and hormonal dysfunction. Patients require a full clinical and endocrine evaluation regardless of the cyst diameter. We report a substantial co-occurrence of RCC and metabolic disorders and primary thyroid diseases, which requires further investigation.

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“…Rathke's cleft cyst (RCC) is the most common nonneoplastic lesion in the sellar region arising from the remnant of Rathke punch (8). Most RCCs originate in the pars intermedia, between anterior and posterior pituitary lobes, with or without suprasellar extension, while a minority of RCC subtype entirely locates above the diaphragm (9,10).…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of delayed postoperative hyponatremia after endoscopic endonasal surgery for Rathke’s cleft cyst: A single-center study

Qian

Zhou

et al. 2022

Front. Surg.

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BackgroudDelayed postoperative hyponatremia (DPH) is common for sellar lesions. However, the true prevalence and associated factors of DPH after endoscopic endonasal surgery (EES) for Rathke’s cleft cyst (RCC) have not been studied in a large patient cohort.MethodsA retrospective analysis was conducted over 6 years at our institution, and patients with RCC treated by EES were enrolled according to our inclusion criteria. Patient demographics, clinical characteristics, images, and surgical procedures were documented. Serum sodium was routinely measured before surgery, on postoperative day 1, and every 2 days thereafter until discharge. For patients with DPH, electrolyte, hematocrit, serum protein levels, and plasma and urinary osmolality were daily measured to explore potential etiology.ResultsOf the 149 eligible patients, 25 (16.8%) developed DPH, which was similar to other sellar lesions, except craniopharyngioma, in the same period in our institution. Significant risk factors suggested by univariate analysis were cyst location, requirement of postoperative hydrocortisone therapy, postoperative meningitis, intraoperative cerebrospinal fluid (CSF) leakage, and subtotal resection (STR) of the cyst wall (all p < 0.05). In addition, other supplementary 11 cases of suprasellar RCC with different surgical strategies (aggressive resection) and relevant factors were enrolled into multivariate analysis. Suprasellar location [odds ratio (OR) 8.387, 95% confidence interval (CI) 1.014–69.365, p = 0.049], requirement of postoperative hydrocortisone therapy (OR 4.208, 95%CI 1.246–14.209, p = 0.021), and intraoperative CSF leakage (OR 6.631, 95%CI 1.728–25.440, p = 0.006) were found to be the independent predictors of DPH.ConclusionDPH is a common complication after EES for RCC. Suprasellar location, requirement of postoperative hydrocortisone therapy, and intraoperative CSF leakage are the most reliable risk factors. Cortisol deficiency and syndrome of inappropriate antidiuretic hormone (SIADH) are considered as the main etiologies of DPH in RCC. Conservative excision of the cyst wall may reduce DPH occurrence.

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High prevalence of adrenal insufficiency at diagnosis and headache recovery in surgically resected Rathke’s cleft cysts—a large retrospective single center study

Cited by 16 publications

References 38 publications

Clinical Characteristics, Management, and Treatment Outcomes of Primary Hypophysitis: A Monocentric Cohort

Clinical Characteristics, Management, and Treatment Outcomes of Primary Hypophysitis: A Monocentric Cohort

Presenting symptoms and endocrine dysfunction in Rathke cleft cysts — a two-centre experience

Incidence and risk factors of delayed postoperative hyponatremia after endoscopic endonasal surgery for Rathke’s cleft cyst: A single-center study

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