Pituitary Cyst - Neurologist ?

[turgid]

I had an MRI which showed i have a pituitary cyst (or tumor but probably a cyst).  I'm interested in seeing a doctor who has some experience with these.

 

Ive always had low testosterone and rather than just medicating  every quarter i was interested to know the cause . The endocrinologist said it was probably genetic and  showed no interest in me having a scan possibly because the 14K Baht every twelve weeks forever  is easy money.  I basically walked in and paid for an MRI at another hospital.  And I have a cyst.  This fits with some other symptoms I've had (dodgy vision and headaches )  but rather than self diagnosing  I'd like to actually talk to someone who knows this stuff. .  I was considering going to Singapore but I'd have to restart the whole process there (the neurologist i wrote to in Singapore got the hump and suggested i was trying to bypass the 15 departments  I was supposed to speak to and pay before him).  I was wondering anyone here has experience or knowledge with pituitary stuff  and could recommend a neurologist in Thailand that will discuss options.  Cutting it out is apparently very dangerous so based on the internet the treatment is either leave it alone or drain it . 

[Sheryl]

Just how large is this cyst? As something like 15% of the population have these and vast majority are asymptomatic and require no treatment at all.

A draw back to MRIs is that they very, very often turn up things like benign cysts and that is often followed by unnecessary further tests and treatments. One reason why unnecessary MRIs are discouraged.

It is unlikely this cyst is responsible for your low T but needs a good endocrine evaluation to be sure and also rule out other hormonal effects. Some pituatary cysts cause these and some do not.

And you should have a visual field acuity test along with general opthalmologic exam. This will help determine if the cyst has a relation to your visual issues.

Endo and opthalmic evals should be done before considering surgery as in most cases it is not necessary. Any ethical/competant neurosurgeon would require this before even thinking of treatment.

In Bangkok I suggest you see Dr. Jun at Bumrungrad for endocrine eval. This should be first step.

For opthalmology work up these doctors have specific experience with effects from pituitary growths:

Prof. Vannakorn Pruksakorn - Chulalongkorn Hospital (try their after hours clinic)

Prof. Supharat Jariyakosol - Chulongkorn as above and also at BNH.

If surgery is indicated the docs I know of doing this are:

Prof. Athikorn Thiabpha - Ramathibodhi Hospital, try through their "Premier Clinic" which is what they call their after hours arrangement.

Prof. Ake Hansasuta - at Ramatbibodhi as above and also at Bumrungrad.



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[snowballthecat]

Hi Turgid, 

I came across  dr Saksit at Phuket International. Excelent neurologist. 

I don't know about pituatary gland but he was very competent analising my MRI's from abroad and explaining my case (hydrocephalous with stenosis).

His recommendation in my case was "wait and see" and "NFA" (no further action), which is exactly what I wanted to hear!

Good luck!

 

[turgid]

Sheryl Thanks as always for the comprehensive response.     I'll try asking my Endo to refer me to the Neurologist.  However to quote an old Irish joke If i'm trying to get where i want to go I really wish i wasn't starting from here.

 

I've  seen 3 different endos.   Basically had low energy for years to the point where all my available energy went into work and in the end  I quit working. The  doctors i'd seen had either suggested anti depressants or legal speed neither of which I wanted to take.    A complete stranger i was talking to on a  plane suggested I should have my T checked. I did it privately because I assumed everyone would think i was a steroid abuser. The result came back under 120 which is very low for a supposedly a healthy male. . So I took that result to  a doctor at Bumrungrad. After the obligatory re-testing he agreed it was crazy low and he said I should take T and put me on Nebido.  Which helped.     After a year I switched Dr. because i felt he wasn't doing a great job in talking cause and effect,   he just wanted to add (everyone your age takes it) blood pressure and statins medication to the bill. So i switched to BCH which was cheaper and friendlier.   The second Endo said the first Endo  should have done some diagnostic testing but there's no point now because the results will be messed up because you are taking T.    I took for a couple more years but then this year wondered if it was working and gave up for six months (it was - i felt like crap after 3 months).  I was visiting a friend in a different hospital. While I was waiting they tried to sell me a health check-up. I  said what would be involved with diagnosing low T here. And they said we can do a blood test and  MRI now if you want but you'll have to chat to an endo first. 2 hours later all done.   The doctor who reviewed the MRI said you have a cyst and Low T  probably caused by the cyst -  keep keep taking the T.

 

As you indicate I've also been told that on autopsy 20% of adults have cysts and most were "symptom free". But prior to asking for it I have never been offered a hormone test in any medical or visit to a doctor.

When I've asked for the correlation between detected pituitary cysts and measured adult hormone levels nobody can actually provide it. So while the majority are considered "symptom free" maybe they just sucked it up and got on with it.   - I did for along time.

And finally being flippant perhaps,  but why were they having Autopsies or MRIs if they were symptom free?