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Pituitary Cyst: Rathke's Cleft Cyst
What Is It?A Rathke's cleft cyst is a benign pituitary cyst which typically occurs in the area of the pituitary gland. It is thought to be a remnant of an embryologic structure called Rathke's pouch, hence the name. If left over after development, the cyst can slowly expand and eventually cause symptoms.Most Rathke's cleft cysts occur in the sella, the area where the pituitary gland sits, although occasionally they can occur in the suprasellar area, above the gland. They are typically consisted of a thin wall with a thick or gelatinous fluid inside. These pituitary cysts can present anywhere from childhood through to late adulthood, although it is most frequently found in older adults. What Types of Symptoms Are Typical?Many Rathke's cleft cysts do not produce any symptoms and can be incidental findings. This is more true of smaller cysts.As they enlarge, they can compress the normal pituitary gland, the pituitary stalk and the optic chiasm above which is important for normal vision. Therefore, symptomatic cysts can cause various symptoms, most commonly including visual disturbances and pituitary hormonal disturbances. These symptoms and when they present vary from patient to patient and depend much on the exact position of the pituitary cyst and its size. How Is The Diagnosis Typically Made?In the case of asymptomatic cysts, they may be found incidentally on CT scan or MRI scan or at autopsy.In the case of symptomatic cysts, after a neurological examination, they are often found on a CT or MRI scan. They appear as a cystic structure in the area of the pituitary gland. While the diagnosis can be fairly confident based on these imaging studies, not all cysts can be distinguished from other pathologies that occur in the region such as a pituitary adenoma or a craniopharyngioma. A definitive diagnosis is made at the time of surgery when the cyst with fluid contents is confirmed and sent to pathology for inspection. In addition, because they can effect normal pituitary function, most patients will undergo a thorough endocrinological work-up with blood tests of several pituitary and related hormones. What Are Some Common Treatments?Asymptomatic cysts are often treated conservatively, watching them on serial scans and waiting until a patient has symptoms.If the decision is made by the patient and their physicians, these pituitary cysts are generally treated surgically. Most can be treated by a transsphenoidal surgery, through the nasal passages. In most cases the cyst can be drained and at least some of its capsule removed. If the cyst wall is strongly adherent to important structures such as the pituitary stalk, small remnants are sometimes left intact. As with other tumors, the specific treatment plan varies from patient to patient and cannot be generalized. Patients should make these treatment decisions with their own personal physician.
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