PITUITARY-FUNCTION IN PATIENTS WITH RATHKES CLEFT CYST - SIGNIFICANCEOF SURGICAL-MANAGEMENT

The pituitary function of patients with Rathke's cleft cyst before and after surgery was investigated to clarify the significance of surgery and operative indications. The authors have treated 19 patients with Rathke's deft cyst. There were panhypopituitarism in 2 patients (11%), amenorrhea and/or galactorrhea in 3 (16%), diabetes insipidus in 4 (2 1%), and visual disturbance in 9 (47%). All the patients underwent sys tematic endocrinological examination and were found to have various de grees of pituitary dysfunction. Panhypopituitarism was endocrinologica lly confirmed in 2 patients. Hyperprolactinemia was observed in 4. The se patients underwent aspiration of the cyst contents and biopsy of th e cyst wall. Postoperative follow-up endocrinologic evaluation perform ed more than 3 months after surgery showed improvement in pituitary fu nction in 9 out of 13 patients (69%). Amenorrhea and/or galactorrhea r ecovered or improved in 100% of patients and visual disturbance improv ed in 89%. However, diabetes insipidus and panhypopituitarism did not improve postoperatively, in any patient. The results of the present st udy indicate that the incidence of pituitary dysfunction in patients w ith Rathke's cleft cyst is higher than suspected and in most eases sur gical intervention improves pituitary function and the clinical status of the patient. Therefore, surgical treatment is recommended even whe n the patient has only mild symptoms or signs, including pituitary dys function, to prevent irreversible panhypopituitarism.