Background Sellar cystic lesion is one of the special types of space-occupying lesions in the sellar region, and their clinical characteristics and risk of hypopituitarism vary among different types of sellar cystic lesions.

Objective To summarize the clinical features of common sellar cystic lesions and analyze the risk factors for pituitary dysfunction.

Methods Clinical data about patients with sellar cystic lesions admitted to the First Medical Center of PLA General Hospital from January 2011 to May 2023 were retrospectively analyzed. Clinical features and endocrine hormone deficiencies were compared among different types of sellar cystic lesions. Logistic regression analysis was employed to identify risk factors for hypopituitarism.

Results This study included 774 patients with sellar cystic lesions, of whom 426 (55.0%) were male, with a mean age at diagnosis of (42.13 ± 16.57) years. The distributions were as follows: craniopharyngioma (303 cases, 39.1%), cystic pituitary adenoma (229 cases, 29.6%), pituitary apoplexy (115 cases, 14.9%), Rathke's cleft cyst (52 cases, 6.7%), pituitary abscess (33 cases, 4.3%), epidermoid cyst (25 cases, 3.2%), and arachnoid cyst (17 cases, 2.2%). Central diabetes insipidus (posterior pituitary dysfunction) mainly occurred in patients with pituitary abscess and craniopharyngioma (P < 0.001). Multivariate logistic regression analysis indicated that age (OR=1.020, 95% CI: 1.004 - 1.037, P=0.013), maximum lesion diameter (OR=1.324, 95% CI: 1.037 - 1.691, P=0.024), and lesion type (including pituitary abscess, craniopharyngioma) were associated with anterior pituitary dysfunction. Specifically, compared with Rathke's cleft cysts, pituitary abscess (OR=23.172, 95% CI: 3.811 - 140.777, P < 0.001) and craniopharyngioma (OR=10.438, 95% CI: 2.049 - 53.186, P=0.005) were more likely to cause anterior pituitary dysfunction.

Conclusion Different types of sellar cystic lesions exhibit significant clinical heterogeneity. In this study, craniopharyngioma and cystic pituitary adenoma are the most common types, while pituitary abscess and craniopharyngioma are more likely to lead to pituitary dysfunction. Maximum lesion diameter, lesion type, and age are independent predictors of anterior pituitary dysfunction.