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What Do Abnormalities In Pituitary Gland Indicate?
Question: Hello Doctor,
I have been seeing an Endocrinologist for months now due to having such high levels of cortisol. My tests have showed that my cortisol is double than the regular amount. I recently had an MRI to detect for any abnormalities in my pituitary gland. I had a call from my doctor saying that i do not show any signs of a pituitary adenoma. She went ahead an advised me to get Cavernous Sinus Sampling procedure. Could it be possible that i have a tumor in my pituitary gland that is unable to show up in an MRI? Also, How is this procedure done? And what would the treatment be once my blood levels are read?
I have been seeing an Endocrinologist for months now due to having such high levels of cortisol. My tests have showed that my cortisol is double than the regular amount. I recently had an MRI to detect for any abnormalities in my pituitary gland. I had a call from my doctor saying that i do not show any signs of a pituitary adenoma. She went ahead an advised me to get Cavernous Sinus Sampling procedure. Could it be possible that i have a tumor in my pituitary gland that is unable to show up in an MRI? Also, How is this procedure done? And what would the treatment be once my blood levels are read?
Brief Answer:
Very small tumors may get missed.
Detailed Answer:
Hi,
Thank you for posting your query.
Most of the pituitary tumors are seen on good quality high resolution MRI. However, very small pituitary tumors may get missed on MRI.
Cavernous sinus sampling test is an outpatient procedure and is completed in 1-2 hours. A catheter is passed from the groin veins to the base of brain, where cavernous sinus (venous space on the sides of pituitary gland) is located. This helps in estimating the amount of blood flow from both sides of pituitary and gives information of presence or absence of pituitary tumor.
In your case, the most likely treatment would be medical, as decided by the endocrinologist. However, it is important to identify the source of excess cortisol.
I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Very small tumors may get missed.
Detailed Answer:
Hi,
Thank you for posting your query.
Most of the pituitary tumors are seen on good quality high resolution MRI. However, very small pituitary tumors may get missed on MRI.
Cavernous sinus sampling test is an outpatient procedure and is completed in 1-2 hours. A catheter is passed from the groin veins to the base of brain, where cavernous sinus (venous space on the sides of pituitary gland) is located. This helps in estimating the amount of blood flow from both sides of pituitary and gives information of presence or absence of pituitary tumor.
In your case, the most likely treatment would be medical, as decided by the endocrinologist. However, it is important to identify the source of excess cortisol.
I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
In my case, how high is the possibility that I have a tumor? And is this procedure done to determine "if" or that I "have" a tumor?
What would be the best treatment Doctor?
What would be the best treatment Doctor?
Brief Answer:
Cavernous sinus sampling decides the side of tumor
Detailed Answer:
Thank you for getting back.
Cavernous sinus sampling test decides which side of pituitary gland the tumor is located.
As I mentioned, the small tumors generally can be treated without surgery, with medications.
However, if the pituitary adenoma is bigger than 10 mm, then, surgery may be needed.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Cavernous sinus sampling decides the side of tumor
Detailed Answer:
Thank you for getting back.
Cavernous sinus sampling test decides which side of pituitary gland the tumor is located.
As I mentioned, the small tumors generally can be treated without surgery, with medications.
However, if the pituitary adenoma is bigger than 10 mm, then, surgery may be needed.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
How will this procedure be able to determine the size of the tumor?
Brief Answer:
This procedure would determine only the side.
Detailed Answer:
Thank you for getting back.
This procedure would only determine the side of tumor, and not the size.
The fact that MRI brain is negative, it means that the tumor is less than 10 mm in size, also called as pituitary micro adenoma.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
This procedure would determine only the side.
Detailed Answer:
Thank you for getting back.
This procedure would only determine the side of tumor, and not the size.
The fact that MRI brain is negative, it means that the tumor is less than 10 mm in size, also called as pituitary micro adenoma.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Last Question Doctor and I thank you for your reply
Since the MRI was negative and the tumor is less than 10mm, wouldn't a cavernous sinus sampling procedure be worthless if the tumor size is less than 10mm and should treatment already take place in the form of medication?
I'm a bit confused as to why I am having this procedure done if the MRI was negative
Since the MRI was negative and the tumor is less than 10mm, wouldn't a cavernous sinus sampling procedure be worthless if the tumor size is less than 10mm and should treatment already take place in the form of medication?
I'm a bit confused as to why I am having this procedure done if the MRI was negative
Brief Answer:
Source of high cortisol should be found.
Detailed Answer:
Thank you for getting back.
Since your cortisol level is high, one has to find the source of this high cortisol. In most people, it is pituitary gland. So, cavernous sinus sampling would help in that.
In a small group of patients, it is adrenal gland and rarely, it can arise from tumors in other locations.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Source of high cortisol should be found.
Detailed Answer:
Thank you for getting back.
Since your cortisol level is high, one has to find the source of this high cortisol. In most people, it is pituitary gland. So, cavernous sinus sampling would help in that.
In a small group of patients, it is adrenal gland and rarely, it can arise from tumors in other locations.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
We spoke a couple days ago regarding a possible micro adenoma in my pituitary gland. I know having high cortisol in your body causes muscle breakdown. Would it be counter intuitive to weight train and do cardio. Although I feel tired and lethargic in the gym I am still able to progress in my weight training regiment. Also, is there anything i can do to prevent or muscle breakdown due to elevated cortisol levels?
We spoke a couple days ago regarding a possible micro adenoma in my pituitary gland. I know having high cortisol in your body causes muscle breakdown. Would it be counter intuitive to weight train and do cardio. Although I feel tired and lethargic in the gym I am still able to progress in my weight training regiment. Also, is there anything i can do to prevent or muscle breakdown due to elevated cortisol levels?
Brief Answer:
You can do gym.
Detailed Answer:
Thank you for getting back.
You can do weight training and cardio at gym. However, please be within your limits, and do not overdo it. If you feel tired, please take breaks.
High cortisol in a short time period would not lead to muscle breakdown. I am sure the treatment would be started soon by the endocrinologist to prevent muscle damage in the future.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
You can do gym.
Detailed Answer:
Thank you for getting back.
You can do weight training and cardio at gym. However, please be within your limits, and do not overdo it. If you feel tired, please take breaks.
High cortisol in a short time period would not lead to muscle breakdown. I am sure the treatment would be started soon by the endocrinologist to prevent muscle damage in the future.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
After the tumor is removed with surgery, will i have to be on any types of medication? If so which one? And are there cases where medication is not needed after surgery?
Brief Answer:
No medications would be needed.
Detailed Answer:
Thank you for getting back.
If the tumor is removes after surgery, no medications would be needed.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
No medications would be needed.
Detailed Answer:
Thank you for getting back.
If the tumor is removes after surgery, no medications would be needed.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Would you happen to know why depression and brain fog would be a symptom?
Brief Answer:
Possibly unrelated.
Detailed Answer:
Thank you for getting back.
Depression and brain fog symptoms are possibly unrelated to the original problem.
Vitamin B12 deficiency and thyroid hormone deficiency should be excluded though.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Possibly unrelated.
Detailed Answer:
Thank you for getting back.
Depression and brain fog symptoms are possibly unrelated to the original problem.
Vitamin B12 deficiency and thyroid hormone deficiency should be excluded though.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
How would a pituitary adenoma come about? I noticed a couple years ago i always felt tired. Not sure if this can be related. It wasnt until this year when i had 2 shots of corticosteroid that i felt the symptoms of cushings disease.
Brief Answer:
There are various presentations.
Detailed Answer:
Thank you for getting back.
Pituitary adenoma can present in multiple ways.
1. It can be asymptomatic and gets picked up incidentally on routine brain MRIs.
2. It can present with symptoms due to excess hormone production- such as due to excess cortisol (Cushing's disease) or growth hormone (acromegaly).
3. It can also present with features of compression over optic nerves/chiasma resulting in vision deterioration.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
There are various presentations.
Detailed Answer:
Thank you for getting back.
Pituitary adenoma can present in multiple ways.
1. It can be asymptomatic and gets picked up incidentally on routine brain MRIs.
2. It can present with symptoms due to excess hormone production- such as due to excess cortisol (Cushing's disease) or growth hormone (acromegaly).
3. It can also present with features of compression over optic nerves/chiasma resulting in vision deterioration.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
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