To DOCTORS Teen with large globular pituitary

[kkrylee]

16 yr old - large globular (9mm) pituitary w/ 2 diff MRI's noted "focus of increased visualized posterior aspect of pituitary fossa". MRI focus on Pituitary "Globular pituitary enlargement w/o focal mass"  "min. mass effect elevating optic chiasm".  Ped Endo said not pituitary b/c hormone tests normal.

Tests by opthamologist, neuro, cardiologist, neurosurgeon, & internist. MRI & MRA brain & cervical, EEG, Lyme West Blot, Heavy metal tests, Spinal Tap, blood tests for CBC, ANA, Iron (Hemochromotosis in family).  Tilt Table shows Orthostatic Hypotension.


4 yrs ago started w/transient total binocular vision loss 10-20 x's a day.

6 mos ago:  Had peripheral vision loss, headache pressure at base of skull, nausea, & dizziness.  Headache, nausea, & dizz. remain constant.   Maxalt & Zomig increase headache to point of laying on floor rolling body back & forth in pain.

New transient symp:
blurry vision, peripheral vision loss, shooting burning pains in head, low blood pressure, tingling/numbness on right side of face & right arm, joint pain, fatigue, whoosing noise.

Absence seizures:::once each: peripheral vision loss w/ dilated pupils that wouldn't constrict to light w/ dizziness & headache: couldn't remember how to spell her name: words came out jumbled:  focal stare,couldn't respond & heard me in slow motion: numb face with blue tint around mouth & on lips

Also hypermobile, particularly hands & recently developed sensitive/strong sense of smell.

Blood test:  Low Uric Acid 2.4, High Vit B-12, High Triglycerides 137, Low TIBC 232, High Iron Sat 55.

Spinal fluid :  Stated hypocellular fluid and high Lymphocytes 95, High RBC 8, Low monocytes 5, Differential 20
Simultaneous Blood work:  Low Lympocytes 24 and High Segs 69.

Has spina biffida occulta, rght breast fibroadenomas, left vert artery ends PICA, IBS, & Right Babinski response.

Please see MRI images on my page under photos. IS PITUITARY NORMAL?

ATCH to check cortisol not done.  

[Deanna L Aftab Guy, MD]

I am not the one to interpret an mri, pubertal girls have pituitaries that appear larger than those not going through puberty, that is where the pediatric neurosurgeon and the neuroradiologist look at the film to decide, they are who I rely on with my patient's mri's.

[kkrylee]

Thank you so much for the response.  We are trying to consult with other pediatric Endocrynologist and have seen 2 Neurologists and 1 Pediatric Neurosurgeon.  They each ran tests but ended with "I don't know".  I won't give up until there is an answer.

But, my main question now:  Does her pituitary seem large, or is that normal size for a teenager (16) as Pediatric Endo said?

I have not been able to find an image of an MRI anywhere that has a big ball like that for a pituitary gland.

Again, Thank you

[Deanna L Aftab Guy, MD]

Very very complex case NOT for peds endo alone, this is a case for a neurosurgeon and sounds like you have seen one but I would go back or get a pediatric neurosurgeon, have to keep with the team, the vision and seizure problems are more concerning to me than the normal pituitary workup, the hormones may develop as deficient overtime so keep your link with your endo but you need neurosurgery and or neuroopthalmology.