To characterise endocrine trajectories after surgery for Rathke's cleft cysts (RCCs) and identify factors associated with pituitary hormonal dysfunction and reoperation. Retrospective single-centre cohort of 177 patients undergoing RCC surgery (2004-2023). Preoperative MRI volumetry, cyst location, histopathology, and longitudinal endocrine assessments were analysed. Early postoperative MRI defined residual cyst status. Reoperation-free survival was assessed by Kaplan-Meier and multivariable Cox regression. Patients were 67.8% women (mean age 44.8 ± 17.0 years); median follow-up was 38.5 months. Preoperatively, 50.3% had anterior pituitary dysfunction, 33.3% hyperprolactinaemia, and 9.0% arginine vasopressin deficiency (AVP-D). Larger cyst volume was independently associated with hyperprolactinaemia and gonadal axis dysfunction, whereas age and sex showed axis-specific associations. Cyst location had limited explanatory value. An inflammatory-metaplastic cyst-wall phenotype was associated with more frequent pituitary hormonal dysfunction at presentation. Postoperatively, hyperprolactinaemia resolved in 78.0% of affected patients. AVP-D increased to 24.3% early after surgery and persisted in 22.0% at last follow-up. Gross total resection was achieved in 82.9%, and reoperation occurred in 15.8%. In landmark analysis, residual cyst on early postoperative MRI remained strongly associated with subsequent reoperation after adjustment for age, sex, cyst volume, and location. Larger cyst volume and an inflammatory-metaplastic cyst-wall phenotype were associated with more frequent pituitary hormonal dysfunction at diagnosis. Most clinically relevant net endocrine changes occurred within the first three postoperative months, supporting standardised reassessment at this time point as a pragmatic early follow-up milestone. Early postoperative MRI residual was strongly associated with reoperation, supporting a function-preserving surgical strategy and risk-adapted follow-up.

Intracranial aneurysms (IAs) and Pituitary Adenoma (PA) coexistence has been reported for decades, yet available evidence remains fragmented. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines to assess clinical features of patients with both conditions and quantify the prevalence of IAs in PA patients. PubMed and Embase were searched up to December 15, 2025. Studies reporting coexistence of IAs and PAs were included. Individual patient-level data (Group 1) and aggregate prevalence data (Group 2) were analyzed separately. Risk of bias (RoB) was assessed using Joanna Briggs Institute tools. All analyses were performed using metaprop function from the meta package in R software. Seventy-one studies met inclusion criteria. Most studies have a low RoB. In Group 1 (74 patients), PAs were predominantly macroadenomas (91.9%), most frequently non-functioning (40.5%). IAs were mainly in the cavernous segment of the internal carotid artery (33%). IA diagnosis occurred significantly later than PA diagnosis (p < 0.01). In Group 2 (5264 patients), the pooled prevalence of IAs among PAs was 4% (95% CI 2-4%; I² = 92.1%, τ² = 1.1050, p < 0.0001). Sex-stratified prevalence was 8% (95% CI: 6%-9%) in females and 6% (95% CI: 4%-7%) in males. IAs sex-specific prevalence was significantly higher in both male and female PA patients as compared to the general population (p < 0.01). Patients with PAs show a higher IAs prevalence compared with the general population, likely reflecting combined hemodynamic, anatomical, and endocrine influences.

Immature PIT-1 lineage tumors are classified as high-risk pituitary adenomas/pituitary neuroendocrine tumors (PitNETs) under the 2022 WHO Classification, yet clinical outcome data remain scarce. This study aimed to characterize clinicopathological features and treatment outcomes of this rare entity. We retrospectively analyzed 13 patients with pathologically confirmed immature PIT-1 lineage tumors who underwent surgery at our tertiary center between January 2022 and December 2024. Diagnoses were established according to WHO 2022 criteria using comprehensive transcription factor (TF) immunohistochemistry. Clinical, radiological, histopathological, treatment, and follow-up data were evaluated. Immature PIT-1 lineage tumors accounted for 4% (21/525) of surgically treated pituitary adenomas, of whom 13 with complete follow-up data constituted the primary analysis cohort. Median age was 37 years (range: 25-73), with female predominance (61.5%). Notably, 61.5% presented with hormonal hypersecretion: acromegaly (38.5%), TSH-secreting tumors (15.4%), and GH-PRL co-secretion (7.7%). All patients had macroadenomas (median diameter 28mm (range: 15-59mm)); 38.5% demonstrated cavernous sinus invasion (Knosp grades 3-4). Immunohistochemically defined plurihormonal phenotype was present in 77% of cases; cytologic atypia was identified in all cases. Despite maximal surgical resection, residual disease persisted in 46% and 31% required reoperation at 16-month follow-up (range: 4-51 months). The median Ki-67 proliferation index was 4% (IQR: 2-10%; range: 1-35%), and the median mitotic count was 4 per 2mm² (IQR: 1-8; range: 1-20). Immature PIT-1 lineage tumors exhibit aggressive behavior with high residual disease rates, with 31% of patients requiring reoperation, 23% receiving adjuvant radiotherapy, and somatostatin analogue resistance observed in two patients. Routine TF immunohistochemistry is essential for accurate diagnosis; management requires maximal safe surgical resection and intensive long-term surveillance.

Transsphenoidal surgery (TSS) is the recommended treatment for Cushing's disease (CD). While low morning serum cortisol (MSeC) indicates early remission, the predictive value of an early postoperative overnight 2mg low-dose dexamethasone suppression test (LDDST) remains unclear. This study compares the accuracy of early postoperative MSeC and LDDST for predicting early and long-term remission after TSS. We retrospectively analysed 342 CD surgical cases, who underwent TSS in our department between 2004 and 2024. Morning cortisol measurements were obtained postoperatively. An overnight 2mg LDDST was performed on postoperative day five, in selected cases, preferentially in those without immediate postoperative biochemical remission (MSeC > 50 nmol/L), rather than as a universal screening test. Immediate postoperative biochemical remission (IPBR; MSeC < 50 nmol/L) was achieved in 170 cases (49.7%). LDDST was performed in 197 cases (57.6%), with complete suppression (< 50 nmol/L) in 137 (69.5%). Remission at first follow-up (3-6 months) was significantly higher in cases with IPBR (99.4%) and/or complete LDDST suppression (98.5%) compared to those without (45.0%; p < .0001*). Long-term remission also correlated significantly with postoperative MSeC and LDDST (p < .0001*). ROC analyses confirmed strong predictive accuracy for remission during first FU (AUC MSeC: 0.9229; LDDST: 0.9413) and long-term (AUC MSeC: 0.8267; LDDST: 0.8058). Five-year recurrence risk was 71.1% without LDDST suppression versus 6.8% with suppression. Early postoperative MSeC and LDDST are reliable predictors of remission after TSS in CD. MSeC < 50 nmol/L safely define biochemical remission. LDDST adds diagnostic value, particularly in cases with borderline, normal or elevated MSeC, and should be included in routine postoperative assessment.