Pituitary Cyst 1.9mm or adenoma

[Hydroseed]

My 10yr old daughter is showing many signs of cushing disease.  She had a MRI of the pituitary showing a 1.9mm lesion.  Two radiologist say this is either a cyst,adenoma,calcification or remnants of rathkes pouch.  We are on a wait and see approach w/the endo.  Who or how can I get an accruate diagnoses as to what this lesion is?  She is still gaining weight, specifically in the face,neck-w/buffalo hump, and stomach area, regardless of diets or exercise.  Also is not following the growth pattern in which she was.

Thanks for any insight or info

[CCF-Neuro-M.D.-PW]

Cushings disease is a clinical diagnosis supported by laboratory tests, so the endocrinologist should be able to tell if it is present or not. Central weight gain alone does not necessarily mean Cushings disease is present without other signs and symptoms of Cushings disease. There are several causes of cushigns disease, and many small pituitary lesions are inactve, so the endocrinologist will have to ascertain if there is an actively secreting pituitary lesion or not - the various types of blood test can help decide this.

A 100% concrete diagnosis requires examination of tissue under the microscope - ie after surgery to remove the lesion. However if there is a small pituitary lesion, many times these are watched conservatively over time with MRI scans. The endocrinologist will need to look for other forms of endocrine dysfunction as well as the pituitary also controls other hormone systems.

Surgery for small pituiatary adenomas can now be successfully done less invasively using keyhole-type surgery through the sphenoidal sinus.

Good luck