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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

  • Endocrine Surgery
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Abstract

Background

Rathke’s cleft cysts (RCC) are lesions that arise from Rathke’s pouch. Though frequently incidental, resulting symptoms in a minority of cases are indicators for surgical resection, which may prove beneficial.

Objective

To characterize a cohort of surgically-resected RCC cases at Oregon Health & Science University; tabulate associated hormonal imbalances and symptoms, possible symptom reversal with surgery, determine recurrence risk; identify predictors of recurrence and headache improvement.

Method

Electronic records of all RCC resected cases (from 2006–2016; 11 years) were retrospectively reviewed. Patients had been evaluated by one neuroendocrinologist using a uniform protocol.

Results

A pathological RCC diagnosis was established in 73 of 814 (9%) surgical pituitary cases. The RCC cohort was 77% (n = 56/73) female, mean age was 39.5 ± 14.9 years at first surgery, and at presentation headache was reported in 88% and visual defects/diplopia in 18% of patients. Initial RCC maximum diameter was 1.3 ± 0.7 cm. The most frequent hormonal deficit was cortisol; 24% of patients had a new adrenal insufficiency (AI) diagnosis, however, 36% also had AI at 3 months post-operatively. Mean follow up was 4.0 ± 4.5 years. Two-thirds of patients (41/62) had headache improvement 3 months post-operatively. Post-operative imaging revealed no residual cyst in 58% (38/65). In those patients with no residual RCC, 29% had recurrence and 71% had long lasting cure. From the 42% (27/65) of patients with residual cyst on post-operative imaging; 59% (16/27) remained stable, 26% (7/27) progressed and 15% (4/27) regressed.

Conclusion

Symptomatic RCC present mostly in women, with a high proportion reporting headaches. Prevalence of AI at diagnosis is high. Surgery may not achieve adrenal axis recovery, but renders a high percentage of headache improvement. Approximately 25% of RCC will recur by 4 years postoperatively. Clinicians should cautiously screen patients with symptomatic RCC, regardless of lesion size for AI.

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Author notes

  1. These authors contributed equally: Fabienne Langlois, Anamaria Manea

Authors and Affiliations

  1. Department of Endocrinology, Centre hospitalier universitaire de Sherbrooke, Fleurimont, QC, Canada

    Fabienne Langlois

  2. Pediatric Endocrinology, Oregon Health & Science University, Portland, OR, USA

    Anamaria Manea

  3. Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

    Dawn Shao Ting Lim

  4. Neurological Surgery, Oregon Health & Science University, Portland, OR, USA

    Shirley McCartney, Christine G. Yedinak, Justin S. Cetas & Maria Fleseriu

  5. Pituitary Center, Medicine and Neurological Surgery, Oregon Health & Science University, Portland, OR, USA

    Maria Fleseriu

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  1. Fabienne Langlois
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Correspondence to Maria Fleseriu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived in this institutional approved retrospective study.

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Langlois, F., Manea, A., Lim, D.S.T. et al. High prevalence of adrenal insufficiency at diagnosis and headache recovery in surgically resected Rathke’s cleft cysts—a large retrospective single center study. Endocrine 63, 463–469 (2019). https://doi.org/10.1007/s12020-018-1784-0

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  • DOI: https://doi.org/10.1007/s12020-018-1784-0

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