Diagnosing and Treating a Rathke Cleft Cyst

Often, Rathke cleft cysts do not cause symptoms and are discovered while a person is undergoing a magnetic resonance scan (MRI) being used to investigate something else. Symptoms occur only when the lesion grows and compresses nearby nerves and structures.

A doctor will perform a physical exam, ask about symptoms, and may order blood tests to check hormone levels, since pressure on the pituitary gland and hypothalamus, can cause changes in these levels. Vision tests may be required if there’s compression on the optic nerves or optic chiasm, which cross directly in front of the pituitary gland. Patients are usually referred to a neuroendocrinologist and/or a neurosurgeon if a Rathke cleft cyst is suspected.

One of the tools the neuroendocrinologist and neurosurgeon will need to diagnose or confirm a Rathke cleft cyst is an MRI scan, which can detect the presence of a mass and determine some of its characteristics. Rathke cleft cyst, can be mistaken for cystic pituitary adenomas or craniopharyngiomas, and in some cases the definitive diagnosis can be known only after surgical excision and testing under the microscope.

The treatment of a Rathke cleft cyst will depend on its size and whether it is causing symptoms. If the mass is small and not affecting other structures, the neuroendocrinologist or neurosurgeon may decide no further treatment is necessary other than long-term observation via imaging and to closely monitor the individual to determine whether the cyst starts to grow and lead to symptoms. A large mass that is compressing surrounding structures and causing pituitary dysfunction or visual changes, though, will often require either complete drainage of the cyst and/or surgical removal of the cyst wall. (See Surgery for Rathke Cleft Cyst)

Since Rathke cleft cysts are known to recur after surgery, the neuroendocrinologist or neurosurgeon will determine how often and for how long follow-up MRI scans are necessary as well as blood tests to see whether there are any abnormal results. Headache and visual-field changes are symptoms that should immediately be brought to the attention of the doctor. A regrowth is successfully managed by repeat surgery, in which either the cyst is drained, or the cyst wall is also removed. In some cases, a patient may develop new hypopituitarism or diabetes insipidus after surgery.