Long-term endocrine outcome of suprasellar arachnoid cysts

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Due to their distinct location, suprasellar arachnoid cysts are known to cause a wide variety of problems, such as hydrocephalus, endocrine symptoms, and visual abnormalities. The long-term outcome of these cysts has not been elucidated. To find out the long-term outcome of suprasellar arachnoid cysts, a retrospective review of the patients was performed. The neurological and endocrine symptoms were thoroughly reviewed.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Forty-five patients with suprasellar arachnoid cysts, with an average follow-up duration of 9.7 years, were enrolled in the study. A comprehensive review was performed of the results of follow-up regarding not only neurological symptoms but also endocrine status. The outcomes of 8 patients who did not undergo operations and were asymptomatic or had symptoms unrelated to the cyst were included in the series.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Surgery was most effective for the symptoms related to hydrocephalus (improvement in 32 of 32), but endocrine symptoms persisted after surgery (4 of 4) and required further medical management. More surprisingly, a fairly large number of patients (14 of 40; 1 was excluded because no pre- or postoperative endocrine evaluation was available) who had not shown endocrine symptoms at the time of the initial diagnosis and treatment later developed endocrine abnormalities such as precocious puberty and growth hormone deficiency. The patients with endocrine symptoms detected during the follow-up included those in both the operated (n = 12 of 32) and nonoperated (n = 2 of 8) groups who had been stable during follow-up since the initial diagnosis.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study implies that patients with suprasellar arachnoid cysts can develop late endocrine problems during follow-up, even if other symptoms related to the cyst have been successfully treated. Hence, patients with these cysts need long-term follow-up for not only neurological symptoms but also endocrine abnormalities.</jats:p></jats:sec>

Case Report: Long-Term Tolvaptan Treatment in a Child With SIADH and Suprasellar Arachnoid Cyst

“…Long-term follow-up results of patients with SAC showed that endocrine disorders can develop even years after the initial diagnosis of the cyst; and new endocrine abnormalities were detected in both operated and non-operated patients. No significant associations were found between surgical treatment and endocrine outcome (14).…”

“…SACs are a well-known cause of hypothalamic-pituitary disfunction due to their anatomical location (14), and a wide spectrum of endocrine disorders can be found in patients with SAC, ranging from isolated hormone abnormalities to panhypopituarism associated with diabetes insipidus (6).…”

Long-term outcome of large sylvian arachnoid cysts: the role of surgery has been exaggerated

“…In our previous study, even in cases of suprasellar ACs, in which the influence of the AC on endocrine function seemed more likely, precocious puberty did not improve after surgery. 19 Regarding developmental delay, neurocognitive function tests were performed in 3 patients over the age of 6 years in the present study. The cases did not show improvement after surgery.…”

Quiste aracnoideo gigante ¿Debe el pediatra alarmarse? a propósito de un caso asociado hemorragia intraquística espontánea.

“…Los pacientes que no han presentado cierre de suturas evidencian aumento del perímetro cefálico, macrocefalia y abultamiento asimétrico del cráneo y en pacientes mayores manifestaciones secundarias a la compresión o irritación por efecto de masa (3). La clínica se correlaciona con la localización, los QA supraselares, asociados a desarrollo de hidrocefalia obstructiva por compresión del foramen de Monroe, manifestaciones visuales y trastornos endocrinos (10), que tienden a persistir, incluso aumentar después de cirugía (11). El TDAH, los desórdenes cognitivos y de desarrollo psicomotor están asociados a QA de fosa media, por hipoperfusión sostenida secundaria al efecto de masa (12).…”