Pituitary MIR

[sue3708]

Hi,

I've had 2 brain MRI's....One in 03 shows a "prominent" pituitary.   I was 33 then.   In 08 i had another MRI due to an elevated prolactin level, it showed a convex superior border with no evidence of lesion or tumor.   both scans were done with and without contrast.   I have had 3 normal prolactin levels since, they believe the increased level was due to Reglan.   My most recent normal test was 5 in March of last year.   The only other abnormality was a mildly elevated cortisol level.   I was seen in 08 by endocrinology and they did a dex supression test and they told me I was fine.

Currently I am having horrible nausea and GI can't find anything ( other than mild gastroparesis found on gastric emptying study in 05 and 06 )    I do have some other neuro symptoms but nothing that reveals anything on a neuro exam....  my equilibrium feels off and I have paresthesia's that come and go....they have done spinal MRI's as well and they are fine.

GI said the next step was to revisit my abnormal Brain MRI.....I had been told it was "fine".    Should I have another one done...my guess is that there wasn't much change in the 5 years between the first two...prominent and convex superior border sound a lot alike to me.     So should I have another MRI?  

Currently 40 year old female, no menstual abnormalities no leaky breasts etc....just awful nausea and disequilibrium and some paresthesias.

Thankd

[Daniel M Prevedello, MD]

Those are great news. Of course people can have pituitary abnormality with a normal MRI, but as long as your hormones are also normal, then there is not to be worried about that. If you still have the neurologic symptoms (nausea, paresthesia, disequilibrium), then you should see a neurologist.

[sue3708]

MRI of the brain and pituitary without and with gadolinium

History: 40 yr old female with prior MRI that noted a prominent pituitary gland without focal mass lesion.   The patients chief complaints are nausea and mild paresthesias

Technique:  Three Tesla MRI the brain and pituitary region was performed with acquisition of routine sequence.  10cc of multihance was administered.

Comparison made with most recent prior exam dated March  7, 2008.

Findings:   Within the brain there is no focus of restricted diffusion.   The craniocervical junction is normal in appearance.   The corpus callosum is well formed.   Bone marrow signal is unremarkable.   There is no abnormal signal in the brain.   There is no mass effect, edema, midline shift, or herniation.    The ventricles and subarachnoid spaces are normal in size.   The basal cisterns are preserved.   No extra-axial fluid collections are seen.   The major arterial and venous flow voids are identified.   The orbits, paranasal sinuses, mastoid air cells are clear.   There is no abnormal parenchymal, meningeal, or ependymal enhancement following gadolinium administration.

High resolution imaging throughout the sella turcica is unremarkable.   The pituitary gland is normal in size with a slightly convex superior margin,  It measures 8mm in maximal craniocaudal dimension, within normal limits.   There is no abnormal signal or differential enhancement following gadolinium administration,   The pituitary stalk is normal in size and not deviated.   No hypothalmic mass is seen .  The sella floor is intact.  Both cavernous sinuses are unremarkable.   The contents of the suprasellar cistern are preserved.   The adjacent sphenoid sinus is well-aerated and clear.

Impression:  Normal MRI of the brain and pituitary.  The pituitary gland has a slightly convex superior border, however it is within normal limits for size with no discernible intraglandular mass seen.

Are these results sufficient to put this issue to bed?

[sue3708]

Thank you...I did the regular endocrine stuff BEFORE the dex test and then I had the MRI with steroid prep...waiting for results.

[Daniel M Prevedello, MD]

Dear Sue3708

People can have pituitary abnormality and normal MRI. What I meant is that you need a full neuro-endocrine work up in order to see if your pituitary gland is working appropriately and if it is or not overproducing hormones.
The MRI will definitely show your brain as well.

When I mentioned you need a neurologist is because your symptoms, like paresthesias and disequilibrium, are not symptoms we see with pituitary adenomas commonly.

The use of steroids before the MRI will not affect the MRI findings but it could affect any endocrine test done during the following days.

Thank you

[sue3708]

Saw Endo who has examined me and reordered Cortisol Binding globulin, AM Cortisol, FT4, and TSH and then a low dose dexamethasone test....I did the first set of bloodwork yest and the dex test this morning.   He does want me to have a repeat MRI as he said it doesn't say that the first two were compared...   I'm still having horrible nausea..   If in fact I have something else going on in the brain this MRI will catch it, right?   It is with and without contrast brain attn to hypothalmus/pituitary.   Also I have to premedicate with steroids as I got a little rash once....do the steroids affect the test?

[sue3708]

Also, my Dr. just called back and said my 7am cortisol level was 1 and the higher limit is .93......

[sue3708]

Thank you for your comment.   I have seen 2 different neurologists, one in 08 (an autonomic specialist who did a tilt table test with some tachycardia and a possible POTS diagnosis) and just recently in August.   A repeat cervical spine MRI was essenially normal.   He didn't feel a repeat brain was needed at this time.    I don't have any signs on a neuro exam but I feel awful.   Also I had a reaction to the contrast (mild) but they make me premedicate for MRI's so I really don't want to have another one if I don't have to.

Just to ease my mind, if there were anything going on brain related would i be seeing other neuro signs?   Would they be constant or intermittant?

Thank you for your time.

[Daniel M Prevedello, MD]

Dear Sue3708

I don't think another brain MRI will bring answers to you at this point. I am not convinced you have any pituitary abnormality.
I would suggest for you to see a neurologist.