what does this mri results mean?

[Jihigg]

Hello, I need some advice regarding the results of an mri I had on my pituitary gland. I have been blessed with good health so unfortunately, I do not know a lot about illnesses and medical procedures.  I am a 52 year old woman. I had an MRI done in January on my neck because of herniated discs. In addition to the herniated discs the mri report came back saying I had an empty sella. So my doctor ordered another mri of my pituitary gland. I just got the report back today and my appt with my doctor is not until april 4. The new mri says, “the sella turcica is occupied mostly with fluid signal intensity. Along the left inferolateral aspect of the sella there is a 9.8x5.4x9.8 mm soft tissue density which is isointense to cortex and may represent patients pituitary gland being displaced inferolaterally to the left by the fluid occupying most of the sella. This cannot definitely be identified in connection with the pituitary stalk, however. The possibility of a partially cystic pituitary mass accounting for this apparent fluid within the sella cannot be excluded.
Impression: abnormal fluid signal intensity collection within the sella which appears to displace the pituitary gland inferolaterally to the left. The possibility of a cystic pituitary mass as the etiology for the fluid signal seen with the sella cannot be entirely excluded.”
I did not get the mri with contrast because I did not know until I got to the hospital that an mri with contrast existed, what is was , or why it was ordered and I did not feel comfortable having radioactive material injected without first researching it or having someone with me to make the decision. Had my doctor discussed it with me before hand, I might have considered it.  I did get sudecks atrophy in my leg from an anthrogram  dye injection  in my knee done in 1990 and could not walk for 8 months, so I am very lary of invasive procedures. I also get allergic reactions to various things.
Worse case scenario, if the results of this mri means I have a pituitary tumor, is it removed even if I do not have any symptoms? I am not having headaches or vision problems. Thanks so much for your help wit this.

[rumpled]

They do not drain the fluid - they take special pains to prevent leaks as leaks are not what they want. Leaks - aka CSF leaks - can cause severe headaches as this is the fluid that bathes your spinal cord and brain and the lowering of the level hurts. A good surgeon has very few leaks - usually they are caused by anatomy issues preventing a good seal (unless, of course, you have a lousy surgeon).

Causes of pituitary tumors/lesions are not known so you are not going to find much on that. Sometimes trauma causes them or childbirth.

When you talk to your surgeon, make sure he has done more than 500 lifetime, 50 surgeries in a year. If not, you want to go see another surgeon. Make sure he uses an endoscope, not a microscope as the endoscope allows him to see more and have a wider view. Ask about packing post surgery - some doctors like to pack your nose with either balloons or gauze and some do not. Some use a fat graft to close the wound in your sella (that is where your pituitary is) and some do not - or may if you need. In other words, surgeon's technique's can vary widely and so you need to talk to several surgeons IMHO and ask what they do so you can decide what you are comfortable with since you are not familiar with the surgery. Do know that all of them will fit you with a halo and no one told me ahead of time about that and post op I was more bothered by the screw holes in my head than my surgery! I have had 12 surgeries and my pit one was really easy. But that depends on the surgeon - some of my friends used other surgeons and they looked a bit tougher coming out.

I do suggest you go to a pituitary center and not just any hospital - that will up your chances of your care and after care of being better as they will know pituitary whereas a normal hospital wing - well - they don't know hormones.

[Jihigg]

Thank you so much for all that information and for taking the time to put it in laymans terms. IT has put my mind at ease. Over the past 10 years I have had my perifiall vision checked because my mom had glaucoma, but i am due for another eye exam.
What exactly do they do if they operate? drain the fluid if there is no mass? IF so, what keeps the fluid from coming back? What causes this? I cant seem to find anything on the web about causes. I am going back april 4th to see the surgeon and discuss the mri, so i have to prepare in the next two weeks all my questions for him. thanks again, and God bless :-)

[rumpled]

I am so glad you have had good health.

MRIs work with magnets - so just for your future information, anytime you get contrast with different machines, they are all different types. MRIs do not require any radiation and the contrast used is not radioactive but is a material that is metallic and can be passed out in urine but the metal helps things light up for a short time. If you have questions, ask the tech and they should explain about radiation or not - but MRIs are very safe.

The pituitary sits in a fluid filled bone pocket - sort of like one of those chocolate covered cherry things - the cherry sits in goo and the outside is hard. Now, what the doctors found with you is that they cherry/pituitary cannot be seen well and all they can see is the CSF (cerebral spinal fluid)/goo. That is empty sell. CSF appears black on MRIs and you cannot see behind it and you don't know what is going behind it.

So your doc ordered another MRI to look at it - normally a good pituitary MRI is with and without contrast. So that is why your doc did not discuss it probably.

Now the second MRI showed a bit more as it focused in on the pituitary. Now they can see the pituitary is squished (not a technical term) and they may be able to see a lesion there but they are not sure. However, the lesion that they see is rather large... it is just under the level of macroadenoma (over 10mm) - but it a micro-adenoma (under 10mm).

The next step is for you to get a lot of lab testing. You need to find out if/how the lesion is effecting you. You may not think you have vision issues - but pituitary usually take it away from the sides so it can be subtle at first.

Other symptoms can vary a lot from healing issues, bone issues, depression/mood issues, sleep problems, pain, fatigue, etc etc - they symptoms can vary by type of lesion and if the symptoms are caused by mass effect or by hormone. It will have to be monitored to see if you need surgery or medication to resolve the lesion.

I had the surgery as have others here - while it seems very scary as long as you have an experienced surgeon (that is crucial), you should be fine.

If you have any other questions - let me know.