Choosing the Right Hospital for Neurology: A Guide to MRI and Pituitary Tumors

Choosing a hospital

Hello, doctor.
I'm here again to seek your advice.
After some time of consultation and reviewing information, I strongly feel that your suggestion to undergo further neurological examination is warranted to check for a non-functional pituitary tumor.
Here are my reasons:
1.
I continue to experience significant daytime sleepiness and fatigue, which seems unrelated to sleep (I have no insomnia issues, and my breathing has improved significantly after major surgery, with a total sleep time of about 7 hours daily).
2.
I have been experiencing long-term blurred vision.
Although the ophthalmologist found no issues, it is not severe enough to cause double vision; however, I have difficulty focusing on both near and distant objects, and sometimes my vision feels slightly dim.
3.
I experience dull headaches both at night and during the day, and I often wake up with a headache.
The upper part of my eyes also feels swollen and painful, especially as my physical activity increases during the day.
When my eyes feel more swollen and painful, my fatigue and sleepiness intensify, making me feel too exhausted to walk.
I also experience a sense of pressure in my head, making it difficult to think; all I want to do is close my eyes and sleep.
Additionally, my hearing seems to have worsened, and I feel sluggish.
4.
I have been struggling with sleep apnea, and I have not been able to identify the cause of the swelling in my nasal cavity and other soft tissues (I have tested for food and allergens, which showed minimal reactions).
The medications from the ENT specialist have had almost no effect.
5.
During my neurological examination, there were no obvious deficits in visual function, and my EEG results were normal.
However, I learned online that EEG tests are often normal in cases of pituitary tumors.
6.
I frequently feel hungry before meal times and often experience low blood sugar, with slight trembling in my hands and occasional feelings of palpitations.
Previous internal medicine tests for thyroid hormones and blood sugar levels were normal.
I have a few questions:
1.
Can I request to pay out-of-pocket for an MRI, and if a tumor is found, apply for insurance reimbursement? What conditions would allow me to qualify for insurance-covered MRI? My symptoms have not improved in nearly two months since my neurological consultation and EEG, and I feel they may be worsening.
2.
Due to location constraints, can I choose any hospital with an MRI for the examination? If a tumor is found, can I request a referral to a neurosurgery department at a larger hospital? I initially wanted to find a closer facility, but I have been advised that the type of MRI machine can affect the results.
3.
I have already undergone a total of six CT scans this year for my head, abdomen, and oral cavity, and I am hesitant to have another CT scan.
Besides MRI, are there other types of examinations that can confirm my condition? I do not seem to have any obvious endocrine issues, with a BMI of 22.
Additionally, due to metal implants, I cannot undergo an MRI for three months.
My ongoing symptoms are quite distressing.

Niming, 40~49 year old female. Ask Date: 2015/11/12

Dr. Gao Chunde reply Neurology

MRI can only be requested through health insurance or paid out-of-pocket; it cannot be done out-of-pocket and then later submitted to health insurance for reimbursement (if it meets the criteria, it will be approved; if not, even if abnormalities are found, it cannot be submitted).
It can be performed at one hospital, and if surgery is needed, the patient must go to another neurosurgery department, but remember to bring a copy of the imaging CD.
MRI is the preferred method for examining pituitary tumors because it is not affected by the bony structures of the skull base.
However, if MRI cannot be performed, a CT scan can be used as a substitute, focusing on detailed scans of the sella turcica area to minimize bony interference, which can still reveal issues.
As for very small tumors that cannot be surgically removed, they are unlikely to cause symptoms as severe as yours.

Reply Date: 2015/11/12

More Info

When it comes to evaluating and managing pituitary tumors, particularly in the context of MRI findings and associated symptoms, it is essential to approach the situation with a comprehensive understanding of the medical implications and the appropriate steps to take. Here’s a detailed guide to help you navigate this process effectively.

Understanding MRI Findings and Symptoms
From your description, it seems you are experiencing a range of symptoms that could be related to a pituitary tumor, including excessive sleepiness, visual disturbances, headaches, and potential endocrine issues. The MRI report you mentioned suggests a suspicious nodule in the pituitary gland, which warrants further investigation.
Pituitary tumors, particularly non-functional adenomas, can often be asymptomatic or present with vague symptoms that overlap with other conditions. The symptoms you describe, such as visual changes and headaches, could be indicative of increased intracranial pressure or compression of surrounding structures due to a mass effect from the tumor.

Choosing the Right Hospital and Specialist
1. Selecting a Hospital: You can choose any hospital that has MRI capabilities for your initial scan. However, it is advisable to select a facility that is known for its neurology or neurosurgery departments, as they will have the expertise to interpret the results accurately and provide appropriate follow-up care. If you suspect a pituitary tumor, a hospital with a dedicated endocrine or neurosurgical team would be ideal.

2. Requesting MRI: If you wish to self-pay for an MRI initially, you can do so. However, if the MRI reveals a significant finding, you can then apply for insurance coverage based on the results. Typically, insurance companies require documentation of symptoms and possibly a referral from a primary care physician or specialist to approve MRI scans.

3. Referral Process: If the MRI indicates a pituitary tumor, you can request a referral to a neurosurgeon for further evaluation and potential surgery. It is common practice for patients to be referred from one facility to another, especially if specialized care is needed.

Alternative Imaging and Diagnostic Options
Given your concerns about the frequency of CT scans and the limitations of MRI due to metal implants, there are alternative imaging modalities that can be considered:
- Ultrasound: While not typically used for brain imaging, it can be useful in evaluating certain conditions.

- PET Scans: Positron Emission Tomography can sometimes provide additional information about metabolic activity in tumors.

- Endocrine Evaluation: Since pituitary tumors can affect hormone levels, a thorough endocrine evaluation, including blood tests for hormone levels, could provide valuable insights.

Addressing Your Symptoms
Your symptoms, particularly the headaches and visual disturbances, should be taken seriously. It is crucial to communicate these symptoms clearly to your healthcare provider. If your condition is worsening, you may need to advocate for more immediate evaluation and intervention.

Conclusion
In summary, navigating the healthcare system for potential pituitary tumors involves understanding your symptoms, selecting the right facilities, and ensuring that you receive appropriate imaging and follow-up care. It is essential to work closely with your healthcare providers, communicate your concerns, and ensure that you receive timely evaluations. If necessary, do not hesitate to seek a second opinion, especially if you feel that your symptoms are not being adequately addressed. Your health and well-being should always be the priority.

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