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Input to opinions of situation and suggestions for direction please.

Hello, my
I would like to give you some information about my situation, in hopes of an opinion or input regarding direction for further care. I will try to be brief by focusing on objective information.
Headaches began 19 years ago,
MRI resulted with a 3mm Pituitary Adenoma.
Unfunctional
Headaches continued/worsened (currently debilitating)
Triptans, Beta Blockers, Mag, muscle relaxers, NSAIDS, opioids, Botox, Aimovig, Emgality (currently), Et al.
Decompression, many ESI’s, ACDF C5-C6.
F/U MRI 5MM still unfunctional
Continued treatment and R/O of Cervicogenic and Migraines with no success.
F/U MRI positive for 5mm + 9mm adenomas with deviation of infundibulum.
NS consult “still nonfunctional/micro cont to monitor”
HA’s now 24/7 along with visual changes/loss, memory loss, dizzyness, intermittent gait/balance trouble, severe hot flashes previously thought to be menopause related (I’m 52) worse than ever (suffering 12 years) (amenorrhea x 3 years).
ACTH increased (80) and remain increased.
Intermittent slightly high Cortisol (21)
MRI now negative for Pituitary Adenoma x 3
MRI for r/o Pseudotumor Cerebri resulted as suggestive for Pseudotumor Cerebri(optic sheaths with tortuosity and CSf) however
LP opening pressure 12 and flow was restricted (table needed to be tilted to collect 11.5 ml CSF specimen)
MRI now showing empty sella with Pituitary gland flattened and concave downward expansion with CSF.

Questions:
3 MRI’s negative for Pituitary Adenoma? Apoplexy?
due to being flattened by CSF/empty sella?

Pituitary issues r/t Headaches and Neuro symptoms?

ACTH consistently increased with borderline and mildly increased Cortisol levels?

Given the above information what if any is the concerns, and course of action?

There appears to be conflicting opinions on effects of Empty Sella, but considering my previous history with my disappearing adenomas, any concern?

My PCP recommends referral to the Cleveland Clinic Neuro/ Endocrine team due to overlapping symptoms/results? Is a NS consult before referral to clinic reasonable?

Thank you,
Sincerely,
Kelly
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