Symptomatic Rathke's Cleft Cyst: A Series of Five Cases and Review of the Literature

Abstract Introduction: Rathke’s cleft cyst (RCC) is a rare benign cystic lesion of the sellar region arising from an embryonic remnant of Rathke’s pouch. Although often asymptomatic, it may become responsible for endocrine, neurological, or ophthalmological manifestations when it is large or compressive. Objective: To describe the clinical, hormonal, radiological, therapeutic, and evolutionary characteristics of symptomatic Rathke’s cleft cysts through a series of five cases. Patients and Methods: A retrospective descriptive study including five patients followed for symptomatic Rathke’s cleft cyst in a university endocrinology department. Results: The mean age was 34.4 years, with a female predominance. The circumstances of discovery were mainly headaches (40%) and endocrine disorders (40%), followed by visual disturbances (20%). All patients presented with partial or global anterior pituitary insufficiency. Hypothalamic–pituitary MRI revealed an intrasellar cyst with protein-rich content consistent with a Rathke’s cleft cyst. Hormonal replacement therapy was initiated in all patients. One patient underwent transsphenoidal surgical treatment. Outcome was favorable, with clinical, radiological, and hormonal stability. Conclusion: Symptomatic Rathke’s cleft cyst should be considered in cases of unexplained hypopituitarism. Management relies on hormonal replacement therapy and surgery in compressive forms. Prognosis is generally favorable with regular follow-up.