Pros/Cons of Pituitary MRI at Kaiser vs Independent Imaging Facility

[l_fitz]

A recent CT scan (due to migraines) showed an enlarged pituitary gland & my doctor has ordered a pituitary MRI with & without contrast.  I have a high deductible HSA plan and still have not met my deductible.  I called Kaiser and they told me I would have to pay $1050.  When I called 5 other independent imaging labs in the metro area - found they all only charged an average of $600 and the cost included interpretation by a Radiologist.  

My question is whether or not it's a good idea to use one of the independents - and if so - are there any things I need to ask or verify about them.  Normally wouldn't consider this, but money is extremely tight due to job loss.  Even though the MRI w/ an independent won't count toward my deductible, it would leave me over $400 toward a visit w/ an Endocrinologist & treatment.

[Daniel M Prevedello, MD]

Dear l_fitz

I agree with Rumpled. Have you done the pituitary MRI?

Thank you

[l_fitz]

Thanks for your comment.  I haven't done the MRI yet. After my Kaiser GP spoke with the Endocrinologist, they decided I should have some lab tests done first to see if perhaps we could postpone or sidestep the MRI altogether (based on my financial situation). Apparently the results were acceptable as the only note I've received back is "Good."  Will obviously need to follow up to see what course of action is next.  Results were as follows:
Prolactin - 7.8
Free T4 - 1.0
Free T3 - 2.92
TSH 3.338 (this is gradually increasing)- 2.819 (Nov '12), 1.574 (Apr '12),  from a high of 7.842 (Feb '12)
I've been taking 20mg of Inderal 2x/day and no longer have any headaches/ migraines.
Currently taking 1/2 tab of 125mcg synthroid daily - but can tell it's getting less effective. I really had expected the blood work to show a problem as I have been generally feeling poorly - fatigued again, struggling to maintain weight (even with calorie reduction/daily brisk walks), swollen tongue, puffy face & dry skin - so am considering next steps.  Probably need to visit the Endocrinologist soon.  Wondering about possibly trying desiccated thyroid vs. synthroid.  Any thoughts re: how best to ensure I stay on top of this?

[rumpled]

If you use one of the independents - just make sure they can do a good quality DYNAMIC pituitary scan and it is with and without contrast. Radiologists can miss smaller lesions (I am stunned a CT picked it up!).

I would call around to pituitary centers in your area and ask their opinion. In the patient forum their are some links to some in the health pages - just do research even though they are listed, not all are good so it pays to be an informed patient.