Endocrine Abstracts

JOINT2991

Background: Rathke’s cleft cysts (RCCs) are benign, sellar or suprasellar cystic lesions of the pituitary gland. While frequently incidental, they can cause symptoms due to mass effects (headaches and/or visual disturbances) or due to endocrine dysfunction. Optimal management remains debated. This review examines the natural history of non-operated RCCs (radiological and endocrine progression) in a single-centre UK cohort.

Methods: Single-centre retrospective review of non-operated RCCs that were conservatively managed between 1/1/2021 and 31/12/2024. Data collection- demographics, presenting symptoms, endocrine function, radiological findings, follow-up outcomes.

Results: 45 patients identified (median age 54 years at diagnosis, IQR 32 – 67 years, range 14 – 88 years). 31/45 (68.9%) diagnosed incidentally. Most common presenting symptom amongst non-incidental cases: headache (10/14, 71.4%). At diagnosis, 42/45 (93.3%) eupituitary. 3/45 (6.7%): hypopituitary (low growth hormone levels, arginine vasopressin deficiency, panhypopituitary with raised prolactin). At diagnosis, median cyst size (maximal diameter) 6 mm (IQR 5 –9 mm). All had full visual fields to confrontation. 1st follow-up: 28/45 (25 eupituitary, 3 endocrine deficit) (62.2%) received follow-up imaging. Median interval to 1^st follow-up- 12 months (IQR 7.5 – 12 months, range 6 – 48 months). 17/45 (37.8%)- waiting for 1st follow-up scan. Biochemical and visual field findings: At 1st follow-up, 25 eupituitary patients at diagnosis, none developed new endocrine deficits. In the 3 patients with endocrine deficits at diagnosis, deficits remained the same. All patients (28/28)- normal visual fields. Subsequent follow-up: Median interval to most recent follow-up- 24 months (IQR 12.75 – 58.50 months, range 7 – 126 months). Biochemical and visual field findings: At most recent follow-up, 25 eupituitary patients at diagnosis, none developed new endocrine deficits. In the 3 patients with endocrine deficits at diagnosis, deficits remained the same. 27/28 (96.4%) normal visual fields, 1/28 (3.6%)- left inferotemporal visual field defect secondary to haemorrhage at 15 months after diagnosis.

Conclusion: The majority of RCCs in our cohort remained stable or regressed, with a low risk of developing new endocrine deficits. Conservative management appears safe, with routine hormonal screening potentially unnecessary in asymptomatic patients. We propose a patient-initiated follow-up based on symptomatic presentation instead of routine screening of non-operated RCCs. Future retrospective and prospective studies with longer periods of monitoring are warranted to further refine surveillance strategies.