Thursday, June 30, 2005

pituitary tumor

My mother started slowly going blind. Her eye doctor found cataracts, but after her surgery to remove them, her vision didn't improve much. At the time, she was taking a prescription medication that's known to cause vision problems, so she figured it was the meds. But during her post-surgical eye exam, her optometrist suspected something else: a pituitary tumor.

But, because Dr. Wess was "only" an optometrist (never mind that the guy's certified in treating ocular disease and he's been an eye doctor for 25 years) the insurance company wouldn't approve an MRI or blood tests for her. So, Dr. Wess wrote a letter explaining his concerns to her regular physician ... who then sat on the letter for a month.

Her doctor finally got around to ordering the MRI for my mother. The MRI showed a great big pituitary tumor that was putting pressure on both optic nerves and had invaded her cavernous sinuses. She needed surgery months earlier. The doctor started acting worried and indignant, saying my mother should have "come in sooner to have this checked out." She not-so-gently reminded him that she did come in earlier, but he told her pituitary tumors are "rare" and probably nothing to be concerned about.

The thing is, pituitary tumors aren't rare -- autopsies and x-ray and MRI data indicate that slightly over 20% of the adult human population has a pituitary tumor at any given time. Many of the people with these tumors of course don't realize they've got one.

Because of the pituitary gland's function, such tumors can oversecrete (or impair the gland so it undersecretes) various hormones, such as:

These imbalanced hormones in turn can cause a boggling array of possible symptoms:

  • unusual darkening or thinning of the skin
  • unusual fat deposits, especially in the face
  • obesity, despite a normal diet
  • aching joints
  • easy bruising
  • carpal tunnel syndrome
  • unusual weakness or fatigue
  • acromegaly
  • Cushing's disease
  • high blood pressure
  • diabetes
  • arthritis
  • mood disorders such as depression
  • thyroid damage
  • sexual dysfunction
  • adrenal gland dysfunction
  • infertility
  • abnormal menstrual cycles
  • osteoporosis
  • false pregnancy signs in women such as lactation
  • accelerated heart disease
  • death due to heart attack, loss of kidney function or deficiency of cortisol

Sometimes tumor sufferers have several of the above symptoms; sometimes they just have one. Most people wouldn't readily associate depression or infertility with a tumor. And some benign, nonsecreting tumors just sit there quietly, causing no symptoms whatsoever.

Nonsecreting tumors can grow large, putting pressure on one or both optic nerves and/or the brain, causing pain, blindness, and other neurologic symptoms. Such pressure can cause permanent nerve damage if not relieved in time. They can break into the sinus cavities, causing pain and sparking secondary infections. And, as with my mother's case, they can wrap themselves around the carotid artery, making surgery dangerous and complete removal difficult if not impossible.

Pituitary tumors are sometimes secondary metastases from primary cancers elsewhere, often from the lung. These metastatic tumors often grow large and ropy, but don't often secrete hormones. They are most troublesome, of course, because they indicate serious cancer elsewhere.

Tumors are difficult to diagnose when they're small, and even small tumors can dangerously overproduce hormones. There have been cases where surgeons have gone in knowing there's a tumor and have been unable to find the tiny pinhead that's been causing problems. MRI scans will display large tumors, but difficult-to-interpret blood tests are needed to diagnose smaller ones.

To make sure you get competent medical assistance, it's important to go to a hospital with a neuroendocrine unit or a pituitary testing facility; preferably the hospital should have both.

Surgery is most often used to remove the tumors; the surgeon goes in through the nose and breaks through a sinus to get to the pituitary, which lies under the brain. Sometimes the surgeon must go in through the upper lip.

Tumors that can't be removed surgically can be destroyed with radiation therapy (high-dose x-rays/proton beams or gamma knife irradiation). The symptoms can be alleviated with drugs that block the pituitary from producing excess hormones. Some of these drugs can also shrink the tumors themselves.

The doctors ultimately put my mother on Parlodel (Bromocriptine), a drug that's had success shrinking such tumors. After a month on the drug, the tumor had shrunk enough that she was able to read a novel, the first time she'd done so in close to a year.