Natural history and surgical outcome of Rathke's cleft cysts—A study from the Swedish Pituitary Registry

Maria Petersson, Katarina Berinder, Britt Eden Engström, Erika Tsatsaris, Bertil Ekman, Jeanette Wahlberg, Pia Burman, Henrik Borg, Peter Siesjö, Per Dahlqvist, Anna Karin Åkerman, Oskar Ragnarsson, Martin Olsson, Petter Förander, Sophie Bensing, Charlotte Höybye

Research output: Contribution to journalArticlepeer-review


Objective: 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. Patients and Design: 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. Measurements: Data included demographics, cyst size, pituitary function, visual defects and surgery. Results: 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)54-61
JournalClinical Endocrinology
Issue number1
Early online date2021
Publication statusPublished - 2022

Subject classification (UKÄ)

  • Endocrinology and Diabetes

Free keywords

  • cyst size
  • hypopituitarism
  • pituitary
  • Rathke's cleft cyst
  • transphenoidal surgery
  • visual impairment


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