Pituitary Macroadenoma

This topic is of personal interest to me because my ex-husband was diagnosed with one of these tumors at age 33. The diagnosis and surgery were one of the most stressful periods of my life. I thought I would share the story with all of you for my blog this week. (Note: He has given me permission to post this story on my blog).

I had just found out I was pregnant with our 4^th child (something the surgeon was amazed by, since these tumors tend to diminish fertility) about 2 days prior to my ex-husband getting a really severe headache. The headache passed and he thought perhaps it was a migraine although he had never had one before. A few nights later he woke up in the middle of the night screaming in pain. He said he had the worst headache of his life and needed to go to the ER. We went to the ER where he spent 18 hours and had a lumbar puncture and head CT without contrast, both of which showed nothing. (Interestingly enough, we learned in class that MR is the modality of choice for pituitary adenoma and I lived through that. The head CT missed the pathology). He was sent home with a diagnosis of migraine and migraine medication. He spent the next two days taking the migraine medication with no improvement, unable to eat, and had to get IV fluids at our family doctor due to dehydration. I took him back to the ER two days later when he woke up with double vision. At that time he had a MR and the adenoma was found. We were told the extreme pain was from the tumor bleeding into his brain.

The surgery was done through his nose. The neurosurgeon went through his sinuses and removed the tumor and all of his pituitary gland. After surgery he looked remarkably like Jimmy Durante. His nose was about 3 times the normal size. He spent 1 night in the ICU and then was transferred to the regular floor. He immediately began having problems with urinary output (way too much, since the pituitary controls fluid balance and his had been removed). We spent a tense few days waiting on the final pathology report before he was told it was a benign tumor. Because the pituitary regulates the thyroid gland and his pituitary had been removed he had to start taking synthroid. It took a long time to get his synthroid dosage correct and over the years he had to have it adjusted several times. He also had some residual peripheral vision defects due to the tumor pressing on his optic nerve. He had sinus trouble where he had never had any previously – many more sinus infections and colds. He has been followed with regular MR, eye exams and endocrinologist visits.

This image is from the web and shows a pituitary macroadenoma pre and post removal.

Reference:

http://neurosurgery.ucla.edu/images/Pituitary%20Program/NF_giant_macroadenoma1.jpg