2026 Proffered Presentations
S084: CHARACTERIZATION OF LONG-TERM ENDOCRINE MORBIDITY FOLLOWING ENDOSCOPIC ENDONASAL RESECTION OF RATHKE'S CLEFT CYSTS IN THE LARGEST LARGE SINGLE-INSTITUTIONAL COHORT
Kaasinath Balagurunath, BA1; Sabrina Heman-Ackah, MD, DPhil, Oxon, MSE1; Christopher S Hong, MD1; Ryan Chrenek, MD1; Erika Yamazawa, MD, PhD1; Daniela Berner, BS1; David Meredith, MD, PhD1; C. Eduardo Corrales, MD1; Rania A Mekary, PhD, MSc, MS2; Timothy R Smith, MD, PhD, MPH1; 1Brigham and Women's Hospital; 2School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University
Introduction: Rathke’s cleft cysts (RCCs) are benign, cystic sellar lesions that can lead to significant symptoms when symptomatic, including headaches, visual impairment, and pituitary hormonal dysfunction. Endoscopic endonasal resection remains the primary treatment for symptomatic RCCs. However, postoperative endocrine outcomes are highly variable and incompletely understood, with reported rates of new hormonal deficits ranging widely. The mechanisms and predictors of postoperative hypopituitarism remain poorly defined, particularly in large, homogenous patient cohorts.
Objectives: We aimed to (1) characterize the incidence and pattern of postoperative hormonal deficits after RCC resection, and (2) identify clinical, radiographic, and surgical predictors of new endocrine dysfunction.
Methods: A retrospective cohort study was conducted on 156 adult patients who underwent endoscopic endonasal transsphenoidal surgery for RCCs between 2008 and 2024 at a tertiary-care academic center. Preoperative and postoperative endocrine data up to 5 years postoperatively were collected and analyzed. Hormonal assays included measurements of cortisol, ACTH, prolactin, growth hormone, and IGF-1. Radiographic features and intraoperative variables were reviewed. Binary logistic regression and three penalized regression models (Ridge, Lasso, Elastic Net) were constructed to identify independent predictors of new postoperative hormonal deficits. Model selection was based on Akaike Information Criterion (AIC). T-tests and chi square tests were not performed to avoid the high type 1 error rate seen with multiple testing.
Results: Among 156 patients who underwent endoscopic endonasal resection of Rathke’s cleft cysts, 48.7% developed postoperative hormonal deficits. The most frequently affected axes were thyroid (73.7%), adrenal (56.6%), and gonadal (30.9%), with most requiring long-term hormone replacement. Multivariable logistic regression (which had the lowest AIC compared to other models) identified two independent predictors of new hormonal dysfunction: preoperative endocrinopathy (OR = 14.66; 95% CI: 5.66–37.97; p < 0.001) and larger lesion maximum diameter (OR = 3.88; 95% CI: 1.40–10.78; p = 0.009). Phi correlation analysis further demonstrated significant associations between postoperative hypothyroidism and both suprasellar extension (φ = 0.26; p < 0.01) and lesion size >1 cm (φ = 0.31; p < 0.001). However, other radiographic features—including stalk adherence, rim enhancement, and T2 hyperintensity—did not appear to predict hormonal outcomes. Penalized regression models confirmed the robustness of these associations, consistently identifying preoperative hormonal dysfunction as the most impactful predictor.
Conclusions: This study represents the largest single-institution analysis to date examining postoperative endocrine morbidity following RCC resection. Endocrine morbidity is the most frequent and clinically meaningful complication following RCC surgery, occurring in nearly half of patients. The presence of preoperative hormonal deficits and larger cyst size independently predicted postoperative endocrine decline, underscoring the need to consider these factors during surgical planning and patient counseling. These results challenge the traditional emphasis on structural complications and highlight that functional gland preservation is now the primary determinant of long-term outcome. Patients with preexisting endocrinopathy or large cysts should be approached cautiously, with preference given to conservative operative techniques that minimize gland manipulation. These findings support a shift toward risk-adapted, function-preserving strategies in the surgical management of RCCs.
