Korean J Pediatr.  2010 Jul;53(7):759-765. 10.3345/kjp.2010.53.7.759.

Risk factor for pituitary dysfunction in children and adolescents with Rathke's cleft cysts

• Lim HH
• Yang SW

• KMID: 2073607
• DOI: http://doi.org/10.3345/kjp.2010.53.7.759

Abstract

PURPOSE
This study evaluated the clinical manifestations of and risk factors for pituitary insufficiency in children and adolescents with Rathke's cleft cysts.
METHODS
Forty-four patients with Rathke's cleft cysts younger than 19 years who visited Seoul National University Children's Hospital between January 1995 and September 2009 were enrolled. Rathke's cleft cysts were confirmed histologically through an operation in 15 patients and by brain magnetic resonance imaging (MRI) in 29 patients. The clinical, hormonal, and imaging features were reviewed retrospectively.
RESULTS
The clinical presentation of symptomatic patients was as follows: headache (65%), endocrinopathy (61%), and visual disturbance (19%). Endocrinopathy included central precocious puberty (18%), diabetes insipidus (14%), general weakness (11%), and decreased growth velocity (7%). After surgery, hyperprolactinemia resolved in all patients, but growth hormone insufficiency, hypothyroidism, and diabetes insipidus did not improve. Pituitary insufficiency except gonadotropin abnormality correlated significantly with severe headache, visual disturbance, general weakness, and cystic size. Suprasellar extension of cysts and high signals in the T2-weighted image on brain MRI were related to hypothyroidism, hypocortisolism, and diabetes insipidus. Multivariable linear regression analysis showed that only general weakness was a risk factor for pituitary insufficiency (R2=0.549).
CONCLUSION
General weakness is a risk factor for pituitary insufficiency in patients with Rathke's cleft cysts. When a patient with a Rathke's cleft cyst complains of general weakness, the clinician should evaluate pituitary function and consider surgical treatment.

Keyword

Rathke's cleft cysts; Pituitary insufficiency

MeSH Terms

Adolescent
Brain
Central Nervous System Cysts
Child
Diabetes Insipidus
Gonadotropins
Growth Hormone
Headache
Humans
Hyperprolactinemia
Hypopituitarism
Hypothyroidism
Linear Models
Magnetic Resonance Imaging
Puberty, Precocious
Retrospective Studies
Risk Factors
Gonadotropins
Growth Hormone