Vol 72, No 5 (2021)
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Published online: 2021-10-22

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

Daniela Dadej1, Katrina Skraba1, Beata Matyjaszek-Matuszek2, Joanna Świrska2, Marek Ruchała1, Katarzyna Ziemnicka1
Pubmed: 34855191
Endokrynol Pol 2021;72(5):505-511.


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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  1. Trifanescu R, Ansorge O, Wass JAH, et al. Rathke's cleft cysts. Clin Endocrinol (Oxf). 2012; 76(2): 151–160.
  2. Teramoto A, Hirakawa K, Sanno N, et al. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology. 1994; 193(1): 161–164.
  3. Cohan P, Foulad A, Esposito F, et al. Symptomatic Rathke's cleft cysts: a report of 24 cases. J Endocrinol Invest. 2004; 27(10): 943–948.
  4. Isono M, Kamida T, Kobayashi H, et al. Clinical features of symptomatic Rathke's cleft cyst. Clin Neurol Neurosurg. 2001; 103(2): 96–100.
  5. Langlois F, Manea A, Lim DS, 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. 2019; 63(3): 463–469.
  6. Rak B, Maksymowicz M, Grzywa TM, et al. Pituitary tumours - a large retrospective single-centre study of over 2300 cases. Experience of a tertiary reference centre. Endokrynol Pol. 2020; 71(2): 116–125.
  7. Larkin S, Karavitaki N, Ansorge O. Rathke's cleft cyst. Handb Clin Neurol. 2014; 124: 255–269.
  8. Brinkmeier ML, Bando H, Camarano AC, et al. Rathke's cleft-like cysts arise from Isl1 deletion in murine pituitary progenitors. J Clin Invest. 2020; 130(8): 4501–4515.
  9. Hama S, Arita K, Nishisaka T, et al. Changes in the epithelium of Rathke cleft cyst associated with inflammation. J Neurosurg. 2002; 96(2): 209–216.
  10. Nishioka H, Haraoka Jo, Izawa H, et al. Magnetic resonance imaging, clinical manifestations, and management of Rathke's cleft cyst. Clin Endocrinol (Oxf). 2006; 64(2): 184–188.
  11. Benveniste RJ, King WA, Walsh J, et al. Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg. 2004; 101(4): 577–584.
  12. Chotai S, Liu Yi, Pan J, et al. Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection. J Neurosurg. 2015; 122(6): 1380–1389.
  13. Cabuk B, Selek A, Emengen A, et al. Clinicopathologic Characteristics and Endoscopic Surgical Outcomes of Symptomatic Rathke's Cleft Cysts. World Neurosurg. 2019; 132: e208–e216.
  14. Culver SA, Grober Y, Ornan DA, et al. A Case for Conservative Management: Characterizing the Natural History of Radiographically Diagnosed Rathke Cleft Cysts. J Clin Endocrinol Metab. 2015; 100(10): 3943–3948.
  15. Wait SD, Garrett MP, Little AS, et al. Endocrinopathy, vision, headache, and recurrence after transsphenoidal surgery for Rathke cleft cysts. Neurosurgery. 2010; 67(3): 837–43; discussion 843.
  16. Kim JE, Kim JH, Kim OhL, et al. Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg. 2004; 100(1): 33–40.
  17. Lillehei KO, Widdel L, Astete CA, et al. Transsphenoidal resection of 82 Rathke cleft cysts: limited value of alcohol cauterization in reducing recurrence rates. J Neurosurg. 2011; 114(2): 310–317.
  18. Sala E, Moore JM, Amorin A, et al. Natural history of Rathke's cleft cysts: A retrospective analysis of a two centres experience. Clin Endocrinol (Oxf). 2018; 89(2): 178–186.
  19. Voelker JL, Campbell RL, Muller J. Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts. J Neurosurg. 1991; 74(4): 535–544.
  20. Morinaga Y, Nii K, Sakamoto K, et al. [A Surgical Case of Aseptic Meningitis and Secondary Hypophysitis due to Rupture of a Rathke's Cleft Cyst]. No Shinkei Geka. 2019; 47(6): 637–645.
  21. Mrelashvili A, Braksick SA, Murphy LL, et al. Chemical meningitis: a rare presentation of Rathke's cleft cyst. J Clin Neurosci. 2014; 21(4): 692–694.
  22. Nader R, Frenkiel S, Mohr G, et al. Rathke's cleft cyst presenting as sphenoid sinusitis. Otolaryngol Head Neck Surg. 2001; 124(2): 174–179.
  23. Acharya SV, Gopal RA, Menon PS, et al. Precocious puberty due to rathke cleft cyst in a child. Endocr Pract. 2009; 15(2): 134–137.
  24. Monzavi R, Kelly DF, Geffner ME. Rathke's cleft cyst in two girls with precocious puberty. J Pediatr Endocrinol Metab. 2004; 17(5): 781–785.
  25. Trifanescu R, Stavrinides V, Plaha P, et al. Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed. Eur J Endocrinol. 2011; 165(1): 33–37.
  26. Aho CJ, Liu C, Zelman V, et al. Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg. 2005; 102(2): 189–193.
  27. Oyama N, Tahara S, Oyama K, et al. Assessment of pre- and postoperative endocrine function in 94 patients with Rathke's cleft cyst. Endocr J. 2013; 60(2): 207–213.
  28. Raper DMS, Besser M. Clinical features, management and recurrence of symptomatic Rathke's cleft cyst. J Clin Neurosci. 2009; 16(3): 385–389.
  29. Andrysiak-Mamos E, Sagan K, Sagan L, et al. Cystic lesions of the sellar-suprasellar region — diagnosis and treatment. Endokrynol Pol. 2018; 69(2): 212–228.
  30. Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016; 101(11): 3888–3921.
  31. Billeci D, Marton E, Tripodi M, et al. Symptomatic Rathke's cleft cysts: a radiological, surgical and pathological review. Pituitary. 2004; 7(3): 131–137.
  32. Eguchi K, Uozumi T, Arita K, et al. Pituitary function in patients with Rathke's cleft cyst: significance of surgical management. Endocr J. 1994; 41(5): 535–540.
  33. Kasperbauer JL, Orvidas LJ, Atkinson JLD, et al. Rathke cleft cyst: diagnostic and therapeutic considerations. Laryngoscope. 2002; 112(10): 1836–1839.
  34. Madhok R, Prevedello DM, Gardner P, et al. Endoscopic endonasal resection of Rathke cleft cysts: clinical outcomes and surgical nuances. J Neurosurg. 2010; 112(6): 1333–1339.
  35. Mukherjee JJ, Islam N, Kaltsas G, et al. Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur. J Clin Endocrinol Metab. 1997; 82(7): 2357–2362.
  36. Nishioka H, Haraoka Jo, Izawa H, et al. Magnetic resonance imaging, clinical manifestations, and management of Rathke's cleft cyst. Clin Endocrinol (Oxf). 2006; 64(2): 184–188.
  37. Sade B, Albrecht S, Assimakopoulos P, et al. Management of Rathke's cleft cysts. Surg Neurol. 2005; 63(5): 459–66; discussion 466.
  38. Wang S, Nie Q, Wu Z, et al. MRI and pathological features of Rathke cleft cysts in the sellar region. Exp Ther Med. 2020; 19(1): 611–618.
  39. Wen L, Hu Lb, Feng Xy, et al. Rathke's cleft cyst: clinicopathological and MRI findings in 22 patients. Clin Radiol. 2010; 65(1): 47–55.
  40. Xie T, Hu F, Yu Y, et al. Endoscopic endonasal resection of symptomatic Rathke cleft cysts. J Clin Neurosci. 2011; 18(6): 760–762.
  41. Zhong W, You C, Jiang S, et al. Symptomatic Rathke cleft cyst. J Clin Neurosci. 2012; 19(4): 501–508.
  42. Komatsu F, Tsugu H, Komatsu M, et al. Clinicopathological characteristics in patients presenting with acute onset of symptoms caused by Rathke's cleft cysts. Acta Neurochir (Wien). 2010; 152(10): 1673–1678.
  43. Noh SJ, Ahn JY, Lee KS, et al. Pituitary adenoma and concomitant Rathke's cleft cyst. Acta Neurochir (Wien). 2007; 149(12): 1223–1228.
  44. Nishio S, Mizuno J, Barrow DL, et al. Pituitary tumors composed of adenohypophysial adenoma and Rathke's cleft cyst elements: a clinicopathological study. Neurosurgery. 1987; 21(3): 371–377.
  45. Tamura R, Takahashi S, Emoto K, et al. GH-Producing Pituitary Adenoma and Concomitant Rathke's Cleft Cyst: A Case Report and Short Review. Case Rep Neurol Med. 2015; 2015: 948025.
  46. Tang C, Qiao L, Zhong C, et al. The Coexistence of Growth Hormone-Producing Pituitary Adenoma and Rathke Cleft Cyst: How Can We Diagnosis Preoperation? J Craniofac Surg. 2018; 29(7): 1887–1889.
  47. Wu W, Jia G, Jia W, et al. Pituitary Adenoma Associated With Rathke's Cleft Cyst: Report of 15 Cases. Can J Neurol Sci. 2018; 45(1): 68–75.
  48. Bosnjak J, Budisić M, Azman D, et al. Pineal gland cysts — an overview. Acta Clin Croat. 2009; 48(3): 355–358.
  49. Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019; 33(6): 101367.
  50. Tamhane S, Gharib H. Thyroid nodule update on diagnosis and management. Clin Diabetes Endocrinol. 2016; 2: 17.
  51. Sayki Arslan M, Sahin M, Topaloglu O, et al. Hyperprolactinaemia associated with increased thyroid volume and autoimmune thyroiditis in patients with prolactinoma. Clin Endocrinol (Oxf). 2013; 79(6): 882–886.
  52. Elenkova A, Аtanasova I, Кirilov G, et al. Autoimmune hypothyroidism is three times more frequent in female prolactinoma patients compared to healthy women: data from a cross-sectional case-control study. Endocrine. 2017; 57(3): 486–493.
  53. Pilli T, Cardinale S, Dalmiglio C, et al. Autoimmune thyroid diseases are more common in patients with prolactinomas: a retrospective case-control study in an Italian cohort. J Endocrinol Invest. 2019; 42(6): 693–698.
  54. Larouche V, Correa JA, Cassidy P, et al. Prevalence of autoimmune disease in patients with prolactinomas and non-functioning pituitary adenomas. Pituitary. 2016; 19(2): 202–209.