Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.
Clin Endocrinol (Oxf). 2022 Jan;96(1):54-61. doi: 10.1111/cen.14622. Epub 2021 Nov 1.
Rathke's cleft cysts are benign, embryological remnants in the pituitary gland. The majority of them are small and asymptomatic but a few may become large, and cause mass effects, pituitary hormone deficiencies and visual impairment. Recommendations for the follow-up of Rathke's cleft cysts vary since data on the natural history are sparse.
Data at diagnosis and at 1, 5 and 10 years for patients with a Rathke's cleft cyst (434 at diagnosis, 317 females) were retrieved from the Swedish Pituitary Registry. Cysts ≤3 mm in diameter were excluded from the study.
Data included demographics, cyst size, pituitary function, visual defects and surgery.
The mean age at diagnosis was 45 years. In patients with cysts <10 mm in diameter (n = 204) 2.9% had pituitary hormone deficiencies and 2% had visual field impairments. Cyst size did not progress during the 5 years. Cysts with a diameter of ≥10 mm that were not operated (n = 174) decreased in size over the years (p < .01). Pituitary hormone deficiencies and visual impairments were more frequent (18% and 5.7%, respectively) but were stable over time. Transphenoidal surgery was performed in 56 patients of whom 51 underwent surgery before the 1-year follow-up. The mean cyst diameter at diagnosis was 18 mm (range: 9─30 mm), 36% had pituitary hormone deficiency, 45% had visual field defects and 20% had impaired visual acuity. One year after surgery 60% had no cyst remnants, 50% had a pituitary deficiency, 26% had visual field defects and 12% had impaired visual acuity. No major changes were observed after 5 years. Twelve of the operated patients had a follow-up at 10 years, in eight the cyst remnants or recurrences increased in size over time (p < .05).
Rathke's cleft cysts with a size less than 10 mm rarely grow and our results indicate that radiological follow-up can be restricted to 5 years. In contrast, progression of postoperative remnants or recurrent cysts is more likely and require long-term follow-up.
Rathke 氏裂囊肿是垂体中的良性胚胎残余物。它们大多数体积较小且无症状，但也有一些可能会增大，从而导致肿块效应、垂体激素缺乏和视力障碍。由于缺乏关于自然病史的数据，因此 Rathke 氏裂囊肿的随访建议存在差异。
从瑞典垂体登记处检索了 Rathke 氏裂囊肿患者（诊断时为 434 例，女性 317 例）的诊断时和 1 年、5 年和 10 年的数据。排除了直径≤3mm 的囊肿。
数据包括人口统计学、囊肿大小、垂体功能、视觉缺陷和手术。
诊断时的平均年龄为 45 岁。在直径<10mm 的囊肿患者（n=204）中，有 2.9%存在垂体激素缺乏，有 2%存在视野缺损。在 5 年内，囊肿大小没有进展。未手术的直径≥10mm 的囊肿（n=174）在数年内会缩小（p<.01）。垂体激素缺乏和视力损害更为常见（分别为 18%和 5.7%），但随着时间的推移保持稳定。对 56 例患者进行了经蝶窦手术，其中 51 例在 1 年随访前进行了手术。诊断时的平均囊肿直径为 18mm（范围：9-30mm），36%存在垂体激素缺乏，45%存在视野缺损，20%存在视力障碍。手术后 1 年，60%的患者无囊肿残留，50%存在垂体功能减退，26%存在视野缺损，12%存在视力障碍。5 年后无明显变化。12 例手术患者在 10 年后进行了随访，其中 8 例随着时间的推移，囊肿残留或复发的体积增大（p<.05）。
直径小于 10mm 的 Rathke 氏裂囊肿很少生长，我们的结果表明，放射学随访可以限制在 5 年。相比之下，手术后残留或复发囊肿的进展更有可能，需要长期随访。
