Pineal cyst discovered in MRI for pituitary gland

[Jules77733]

An MRI of my pituitary gland last week revealed a 13mm "simple nonenhancing pineal cyst". My pituitary was being imaged for thyroid problems I've been experiencing for the past three months (fluctuating TSH leaning more toward hypo yet elevated RAI uptake, a litany of symptoms like my neck being swollen and tight on one side, etc.). In addition to experiencing symptoms most clearly related to thyroid problems, I have also experienced terrible headaches, which seem to be increasing in intensity of pain and pressure, and sometimes leave me feeling really nauseous and occasionally dizzy (I actually threw up in late April as a result of one of these headaches, and almost did this in late March, too).

I've experienced headaches my whole life, but my doctor at the time never seemed to worry too much and everyone seemed to write it off as a result of allergies. I'm becoming increasingly worried due to just how bad the headaches are getting, and the fact that my vision changed dramatically over the past two years (it got 3 - 4x as worse as it usually does over a two-year timespan), my eyes are becoming extremely photosensitive especially at night, and when I'm driving at night and looking at a road sign illuminated by my car's headlights, I can see a second, though much lighter/fuzzier, image forming. I was also diagnosed with sleep apnea, though I'm not overweight and don't snore.

What course of treatment, if any, would you recommend for this? What do "simple" and "nonenhancing" mean in relation to this cyst? Is it guaranteed to be a "cyst" (the radiologist reading my results doesn't image many pituitaries, so he's more of a "general" radiologist who interprets images of all parts of the body, and not necessarily a specialist in this area)? And finally, do you think there's any way this cyst is contributing to my thyroid problems by affecting my pituitary gland or something?

I'm a 22 year-old female; history of consistent headaches throughout childhood/adolescence, some of which were "migraines." Onset of seemingly contradictory "thyroid" problems in 4/2008, headaches seemed to get much worse around this time, too. Diagnosed with "obstructive" sleep apnea in July 2007, though no obstruction was ever found (and I asked about this and my ENT said it was probably allergies or my tonsils; a few weeks ago I wondered if this might be neurological).

Thank you so much for your help! I'm planning on going to graduate school in late August, so this incidental, though worrisome, finding has me a little freaked out since this "cyst" appears symptomatic to me...

[DrNoopurMD]

Hi,

How are you?
Pineal cysts are mostly an incidental finding as they are usually asymptomatic. Sometimes however they may enlarge and produce pressure symptoms like headache and eye sight problems as the pineal gland is very close to the optic nerve.
A radiologist is trained to interpret radiographic findings of any part of the body, so he will be able to diagnose a pineal cyst if he sees one.
It is very unlikely that the pineal gland is responsible for your thyroid problems for the simple reason that pineal gland secretes only melatonin. Melatonin is the hormone that controls our sleep wake cycle.
Please seek opinion of an experienced neurologist to decide the best course of action. Also if possible consult an ophthalmologist to rule out other causes of eye symptoms. Take care!

[898]

The simple cyst means it is filled with liquid, has no solids; the non-enhancened means it appear uniform on the scan image [without bright spots].
"The most common group of symptoms associated with pineal region tumors are those relating to increased pressure in the head. These include headache, nausea and vomiting. Because of their location, Pineal tumors can cause Parinaud's syndrome. This is an inability to look up."
So far there are three types of treatments are mentioned in the literature: open brain surgery , long needle aspiration under stereo MRI view and "radiation knife resection" using beam of gamma particles to cut the cyst out [I don't have full understanding of the last method as I need to understand what is going to happen to the fluid from the cyst.