Tuesday, February 23, 2010

Removing Tumors Through the Nose

Wednesday, February 17, 2010 3:58 PM EST


A brain tumor caused one woman's body to grow uncontrollably.

"It took me from being one person to being a completely different person," Erin Kelley (Cushing’s Help message board member)  said.

Each year, 10 to 15-million Americans are diagnosed with Cushing's Syndrome. It occurs when the body is exposed to high levels of the hormone cortisol, often caused by a benign tumor deep inside the brain.

Now, doctors have been saying that a new kind of tool can make removing these tumors an easier process on the patient.

A year ago, Kelley felt like her body was out of control.

"I gained 120 pounds, went from being an extremely athletic person to not being able to do much at all without getting really sick," Kelley said.

Kelley was diagnosed with Cushing's Syndrome. A tumor on her pituitary gland was throwing off her body's hormonal balance.

Traditionally, removing pituitary tumors means making an incision underneath the lip and going through the nasal cavity to reach the tumor.

Dr. Richard Chole, otolaryngologist at the Washington University School of Medicine in St. Louis, Missouri, invented a new instrument that allows him to do the same surgery with a less-invasive approach through the nose.

"It allows us to do it safely through the nose without any incisions," Chole said.

The blades of his tool expand the sinuses, exposing the pituitary tumor and clearing a path for it to be pulled out through the nose. The device eliminates the need for incisions, avoids any possible nerve damage in the mouth, and there's no swelling or eating issues afterwards.

"This way is more direct. The exposure is just different, and it's proving to be a very successful way of doing it," Chole said.

"I am 900 percent better than I was before," Kelley said.

Less than six months after surgery, Kelley's feeling more like herself every day and has dropped nearly half of her weight. Now that her tumor's history, she's taking her life back.

People who are obese and have type two diabetes and high blood pressure have an increased risk of developing Cushing's Syndrome.

Doctors said the new technology may be useful for other kinds of brain tumors as well.

Medical Breakthroughs Research Summary

Topic:       Removing Tumors Through The Nose
Report:      MB #3104

Cushing's Disease: Cushing's Syndrome is a hormonal disorder caused by prolonged exposure to high levels of cortisol. The condition most often affects adults aged 20 to 50, and people who are obese and have type 2 diabetes along with poorly controlled glucose and high blood pressure are at higher risk of developing the condition.

According to the National Institutes of Health, many people develop Cushing's Syndrome because they take glucocorticosteroids like prednisone.

However, pituitary adenomas or tumors that arise in the brain's pituitary gland account for 70 percent of Cushing's cases besides those linked to use of glucocorticosteroids. The benign tumors cause the pituitary gland to secrete extra ACTH, a hormone that stimulates the adrenal glands to release cortisol.

The adenomas are five times more common in women than in men.

Treatment of Cushing's Syndrome depends on the cause and may involve surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs.

Surgery: According to the National Institutes of Health, the cure rate from surgery to remove tumors associated with Cushing's disease is more than 80 percent when performed by a surgeon with extensive experience; and if the first surgery fails, it can be repeated, often with good results.

One type of surgery to remove pituitary tumors involves making an incision underneath the lip to access the sinuses.

"The incision is uncomfortable," Chole said. "It takes time to heal. Some of the nerves are affected by it, and that takes some time to recover."

The surgery also carries risk of damage to tooth roots.

Another approach is endoscopic surgery through the nose. Chole uses a specially designed tool to remove the tumors. The instrument is transferred through an endoscope carrier, and two blades are expanded once inside the operating area.

"The instrument spreads in a certain way to expose the area of the pituitary gland," Chole explained.

"The complexity of the instrument is that it will open and adjust in several different ways, depending on exactly what exposure is needed and the exact anatomy inside that particular person."

Chole also in addition to eliminating the need for incisions, this surgical approach avoids the problem of nerve damage in the mouth and reduces postsurgical complications like swelling and trouble eating.

For More Information, Please Contact:
Judy Martin
Public Affairs
Washington University School Of Medicine, St. Louis


From http://www.newschannel5.com/global/story.asp?s=12000231


  1. "People who are obese and have type two diabetes and high blood pressure have an increased risk of developing Cushing's Syndrome."

    I thought it was the other way around? Can the tumor be caused by being large?

  2. I thought it was the other way around, too. I had meant to post a comment before and got sidetracked :(

    I am pretty sure that it's the Cushing's that causes the symptoms, not that Cushing's is a side effect of obesity.

    Maybe, someday, they'll make a discovery that shows this but at the moment, conventional wisdom says that Cushing's is the culprit.