Long-term endocrine trajectories and reoperation risk after surgery for Rathke’s cleft cysts: a single-center cohort study of 177 patients
Authors' conclusion
Larger cyst volume and an inflammatory-metaplastic cyst-wall phenotype were associated with more frequent pituitary hormonal dysfunction at diagnosis. Most clinically relevant net endocrine changes occurred within the first three postoperative months, supporting standardised reassessment at this time point as a pragmatic early follow-up milestone. Early postoperative MRI residual was strongly associated with reoperation, supporting a function-preserving surgical strategy and risk-adapted follow-up.
Study context
- Population
- Patients undergoing surgery for Rathke's cleft cysts (2004–2023); 67.8% women, mean age 44.8 ± 17.0 years
- Participants
- 177 patients
- Outcome
- Endocrine trajectories and reoperation after RCC surgery
- Follow-up
- Median 38.5 months
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- Preoperative anterior pituitary dysfunction
- 50.3%
- Preoperative hyperprolactinaemia
- 33.3%
- Preoperative arginine vasopressin deficiency (AVP-D)
- 9.0%
- Hyperprolactinaemia resolved postoperatively (of affected)
- 78.0%
- AVP-D early after surgery
- 24.3%
- AVP-D at last follow-up
- 22.0%
- Gross total resection
- 82.9%
- Reoperation
- 15.8%
Observational data: associations, not effects.
Further findings
Factors associated with preoperative pituitary dysfunction
- Larger cyst volume independently associated with hyperprolactinaemia and gonadal axis dysfunction; age and sex showed axis-specific associations
- Cyst location had limited explanatory value
- Inflammatory-metaplastic cyst-wall phenotype associated with more frequent pituitary hormonal dysfunction at presentation
Residual cyst on early postoperative MRI and reoperation
- Residual cyst strongly associated with subsequent reoperation after adjustment for age, sex, cyst volume and location
- Landmark analysis
Original publication
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