SFEBES2021 Poster Presentations Late Breaking (60 abstracts)
Objective: Clinical management of pituitary cysts remains controversial, especially if asymptomatic. We retrospectively review clinical management and outcome of these patients undergoing long-term follow-up in our pituitary clinic.
Methods: All patients with MRI-based diagnosis of pituitary cyst were included. Clinical presentation, cyst size and endocrinopathies (secondary adrenal, thyroid or gonadal deficiency) were compared between surgical and observational cohort. Macrocyst were defined as lesion ≥1 cm in maximal diameter on imaging,
Results: Of 82 patients, 85% were observed with surveillance imaging and 15% underwent pituitary surgery at presentation. When compared to the observational cohort, the surgical cohort had a preponderance of females (100% v.s. 72%) older in age (57 v.s. 47 years), presenting with macrocyst (100% v.s. 21%). The surgical cohort had a higher incidence of visual dysfunction (50% v.s. 7%) and endocrinopathies (33% v.s. 14%), whilst 80% of pituitary cysts were incidentally found in the observational cohort (v.s. 41%). During a mean follow-up period of 63 months in the observational cohort, the pituitary cyst remained static in 61%, decreased in size in 22% and increased in size in 17% (n = 10). Of 4 patients who underwent surgical decompression, 3 had an increase in size during imaging surveillance. Overall, 20% of patients (n = 16) underwent surgery in our cohort. Improvement in vision was noted in 66% of those with prior visual abnormality. Recovery of previous endocrinopathy only occured in 1 patient. Incidence of new endocrinopathy post-surgery was 50%. Of 12 patients with longitudinal imaging follow-up, re-accumulation of cyst was noted in 5 (42%) and repeat surgical decompression was needed in 2 patients.
Conclusions: Majority of pituitary cysts can be managed conservatively, with a low risk of progression necessitating surgical intervention over a mean follow-up of 5 years. Risk of new endocrine dysfunction and cyst re-accumulation is high in those requiring surgical decompression.
08 Nov 2021 - 10 Nov 2021