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Clinical practice survey of incidentally detected pituitary cysts (excluding cystic adenomas or craniopharyngioma)

With increasing frequency of MRI imaging used for the investigation of headaches and other neurological symptoms, the incidence of incidental pituitary lesions has shown a parallel increase. Of these incidental lesions, small cysts within the pituitary gland are the most frequent, often representing developmental / Rathke’s cleft cysts. To understand the current management of such lesions, we would be grateful for your help in completing the below short survey. The survey relates to simple cysts, and excludes cystic adenoma and craniopharyngioma, and additional pathologies with a solid component to the cystic lesion.
1.Your position:(Required.)
2.Do you have access to a pituitary MDT?(Required.)
3.Area of practice:(Required.)
4.Region:(Required.)
Case based survey
Case 1

A 27-year-old lady had an MRI Head for further investigation of headaches. The MRI detected a likely 3mm pituitary cyst.

Would you do:
5.Baseline pituitary function(Required.)
6.If yes, please indicate which tests you would undertake
7.Request a dedicated pituitary MRI(Required.)
8.Visual fields assessment:(Required.)
9.Following the baseline scan, would you re-image the pituitary(Required.)
If yes, frequency of surveillance imaging and duration
10.Frequency of imaging surveillance
11.For how many years would you undertake surveillance scans if there is no change in appearance/ size of cyst?
12.Would you follow up for longer if cyst was not located in pars intermedia?(Required.)
13.Would you follow up for longer if cyst was suprasellar?(Required.)
14.Would you discuss at the local or regional pituitary MDT?(Required.)
15.Additional Comments
Case 2

A 42-year-old male had an MRI Head for further investigation of headaches. The MRI detected a 6 mm pituitary cyst. He then went on to have a dedicated pituitary MRI that showed a purely cystic intrasellar lesion.

Would you do:
16.Baseline pituitary function(Required.)
17.If yes, please indicate which tests you would undertake
18.Request a dedicated pituitary MRI(Required.)
19.Visual fields assessment:(Required.)
20.Following the baseline scan, would you re-image the pituitary(Required.)
If yes, frequency of surveillance imaging and duration
21.Frequency of imaging surveillance(Required.)
22.For how many years would you undertake surveillance scans if there is no change in appearance/ size of cyst?(Required.)
23.Would you follow up for longer if cyst was not located in pars intermedia?(Required.)
24.Would you follow up for longer if cyst was suprasellar?(Required.)
25.Would you discuss at the local or regional pituitary MDT?(Required.)
26.Additional Comments
Case 3

A 55-year-old lady had an MRI Head for further investigation of headaches. The MRI detected a 9mm pituitary cyst. She then had a pituitary MRI which detected a purely cystic intrasellar lesion.

Would you do:
27.Baseline pituitary function(Required.)
28.If yes, please indicate which tests you would undertake
29.Request a dedicated pituitary MRI(Required.)
30.Visual fields assessment:(Required.)
31.Following the baseline scan, would you re-image the pituitary(Required.)
If yes, frequency of surveillance imaging and duration
32.Frequency of imaging surveillance
33.For how many years would you undertake surveillance scans if there is no change in appearance/ size of cyst?
34.Would you follow up for longer if cyst was not located in pars intermedia?(Required.)
35.Would you follow up for longer if cyst was suprasellar?(Required.)
36.Would you discuss at the local or regional pituitary MDT?(Required.)
37.Additional Comments