Korean J Pediatr 2010;53(7):759-765
Risk factor for pituitary dysfunction in children and
adolescents with Rathke’s cleft cysts
Received: 12 March 2010, Revised: 14 April 2010
Accepted: 3 June 2010
Corresponding author: Sei Won Yang, M.D.
Department of Pediatrics, College of Medicine, Seoul
National University, 28 Yeongun-dong Jongro-gu, Seoul
Tel: +82.2-2072-2811, Fax: +82.2-743-3455
Copyright © 2010 by The Korean Pediatric Society
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
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.
Key words: Rathke’s cleft cysts, Pituitary insufficiency
Han Hyuk Lim, M.D.1 and Sei Won Yang,
Department of Pediatrics1, School of Medicine,
Chungnam National University, Daejeon
Department of Pediatrics2, College of Medicine, Seoul
National University, Seoul, Korea
Rathke’s cleft cyst (RCC) is a non-neoplastic lesion lined by a
single layer of epithelium in the sellar and suprasellar regions and
is often discovered incidentally1-3). RCC has been reported rarely in
children and adolescents, and may not be discovered clinically until
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Korean J Pediatr 2010;53(7):759-765 • DOI: 10.3345/kjp.2010.53.7.759
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