Posted by Brigham and Women's Hospital May 29, 2013
Authors: This blog post was written by Dr. Edward Laws and nurse practitioner Sherry Iuliano, from the Pituitary and Neuroendocrine Center at Brigham and Women’s Hospital (BWH). Directed by Dr. Laws, the Pituitary and Neuroendocrine Center specializes in the diagnosis and treatment of pituitary disorders, including pituitary tumors, the third most common primary brain tumor.
The normal pituitary is about the size of a pea, and is considered the “master gland”. The pituitary secretes many essential hormones, including growth hormone. As children, we need growth hormone and as adults we require some, but in large amounts this can be harmful, causing a condition known as acromegaly. The most common reason for overproduction of growth hormone is the presence of a pituitary adenoma, which is a benign (noncancerous) tumor of the pituitary gland.
Compared to the healthy population, patients with untreated acromegaly have a 10-15 year reduction in life expectancy. Untreated, this disease is associated with a mortality rate 2 to 4 times greater than the general population, and is associated with hypertension, diabetes mellitus and cardiovascular disease.
Patients with acromegaly can go undiagnosed for many years before being successfully treated, such as a young man we recently saw in the Pituitary and Neuroendocrine Center. Our patient had been evaluated elsewhere for severe headaches which were accompanied by occasional blurred vision and sensitivity to light. His daily headaches had started three years before he came to our clinic, occurred mainly on the right side of his head and interfered with his daily life. He would awake with moderate pain that increased in severity by late afternoon. An MRI of his brain revealed a very large benign pituitary tumor (macroadenoma) compressing his optic nerves.
The day we met him in our clinic, our patient was quite concerned about the MRI findings, although relieved to have an answer to his symptoms. When questioned about his past medical history, we discovered he also had elevated triglycerides, blood pressure and blood sugars. He snored, but had never been evaluated for obstructive sleep apnea. He also experienced excessive sweating and mild fatigue and his lower jaw had enlarged over the years, increasing the spacing between his teeth. When questioned about the size of his hands and feet, he agreed that he had noticed some enlargement in both, but assumed this was related to his weight gain. His appearance and symptoms led us to believe he had acromegaly. Endocrine blood tests confirmed high levels of growth hormone and another hormone, Insulin-like Growth Factor-1 (IGF-1).
We were able to successfully remove his pituitary tumor using endoscopic trans-nasal surgery. After the surgery our patient’s growth hormones returned to normal, he was headache free and his energy returned to normal. Most importantly, he was able to resume his normal activities, enjoying life with his wife and young children. Though pituitary tumors can cause significant health problems, the good news is that they can be treated and many patients will resume normal lives.
To learn more about pituitary tumors: