Saturday, September 29, 2012

Dr. Redmond, Johns Hopkins Pituitary Day

MEETING NOTES : Dr. Redmond, Johns Hopkins Pituitary Day

Meeting Created: September 29, 2012, 12:07 PM

radiotherapy indications
  • recurrence
  • persistent hormone secretion
  • inoperable
tumors repair more slowly than normal cells

IMRT (Intensity modulated radiation therapy)

stereotactic radiosurgery

  • more radiation beams, greater precision
  • very small tumors 1-5 treatments
  • larger 5-6 weeks
  • 150-300 radiation beams target area
  • Synergy machine
  • for divided course of radiation

cyberknife for 1-5 treatments

  • short-term 
  • fatigue
  • hair loss
  • tearful or dry eye
  • headache
  • nausea
  • long-term
  • cataracts
  • decreased hormones
  • damage to vision (rare)
  • second tumor (rare)
  • tumor control 90%
  • hormone normalization 60%

Dr. Ishii, Johns Hopkins Pituitary Day

MEETING NOTES : Dr. Ishii, Johns Hopkins Pituitary Day

Meeting Created:September 29, 2012, 11:41 AM


patient participation is most important

waiting for other doctor's computer

nasal issues pst-op

nose is good corridor to pituitary, endoscope

nose: smells, filters air, air flow


post-op care

CSF leak


Dr. Gary Gallia, Johns Hopkins Pituitary Day

MEETING NOTES : Dr. Gary Gallia, Johns Hopkins Pituitary Day

Meeting Created:September 29, 2012, 11:11 AM


pituitary lesions, surgery


confined to sella, outside sella

surgical risk
CSF leak

recovery variable

29 YO f with Cushing's

cheerio is 13mm

cortisol below 2 after surgery

Dr. Barbara Craven, Johns Hopkins Pituitary Day

MEETING NOTES : Dr. Barbara Craven, Johns Hopkins Pituitary Day

Meeting Created:September 29, 2012, 10:49 AM


Cushing's, cyclical

started noticing problems early 1990s
1993 people told her she had a red face, 3 little kids
mood swings, depression
gaining weight
1997, Christmas, puffy face, tired, red face, no energy
internist, bloodwork
Epstein-barr virus high, mono.
bone biopsy - rule out cancer. bones too soft, fractured hip in 2 places falling from horse

1998, mole growing on back, removed.  then more and more, every 2 weeks mole removed, all pre-cancerous, melanoma

immune system compromised

2000, racing heart, aching in chest, cardiologist, testing for heart, beta blocker for BP

2001, getting pudgier, weight increasing, tai kwondo, still couldn't lose weight.  800 calories per day, still gaining, shrunk, hair started falling out

dermatologist, no problem.  blood test.  took cortisol and DHEA

endocrinologist (not pituitary), dex suppression test positive

MRI of pit and adrenals.

Dr. Salvatori

hard to diagnose, 9 more months of testing, UFCs, blood, symptoms but not positive tests, salivary was positive

swollen feet, chest hurting, sleeping in recliner, memory became terrible, 
depressed, anxiety, panic attacks, miserable, couldn't fly due to anxiety. Agreed to surgery

removed whole pituitary, only found soft spots.  didn't find pituitary tumor.  found 3mm ACTH tumor

hormones still messed up even though in remission

2006 feeling better

even now hormones can get out of balance. DI.  DDVAP

sodium got low. stopped DDVAP.  drink a lot of water now.

stick with it, don't give up.

Dr. Craven was our guest in the Guest Speakers Interview series.

Dr. Subramarnian, Johns Hopkins Pituitary Day

MEETING NOTES : Dr. Subramarnian, Johns Hopkins Pituitary Day

Meeting Created:September 29, 2012, 10:28 AM



diseases and surgery of the eye
vision loss
peripheral field loss
double vision
kinetic perimetry
5 case studies


can find pituitary tumor through vision

Johns Hopkins Pituitary Day

MEETING NOTES : Johns Hopkins Pituitary Day

Meeting Created:September 29, 2012, 10:04 AM


Dr. Gary Wand

pituitary slides, growth hormone, ACTH
prolactin, breast milk
anterior, Oxytocin
ADH, vassopressin, sodium, diabetes insipidus
micro/macro adenoma
secretory vs nonfunctional
normal MRIs compared to tumors

compression of pituitary
  • thyroid: energy, weight, mental function, skin, temp
  • sex hormones, drive and function
  • adrenal: light-headed, fatigue, appetite, weight, GI
Compression of surrounding structures like optic nerve

Excess hormones: prolactin, GH or cortisol

34% prolactin
36% nonfunctioning

signs from compression
diminished pituitary: sex hormones, thyroid, adrenal
visual defects
no medication
no hormone excess

some surgery
rarely radiation

growth hormone - acromegaly

cortisol, Cushing's

tsh tumor, similar symptoms to Grave's

other pit disorders

Friday, September 21, 2012

Dr. Amir Hamrahian Answers Our Questions About Cushing's and Korlym

October 1, 2012 at 6:30 PM eastern, Dr. Amir Hamrahian will answer our questions about Cushing's, pituitary or adrenal issues and Korlym (mifepristone) in BlogTalkRadio at


You may listen live at the link above.  The episode will be added to the Cushing's Help podcast after the show is over.  Listen to the podcasts by searching for Cushings in the iTunes podcast area or click here:


Dr. Hamrahian has had patients on Korlym for about 4 years.


Please submit your questions below or email them to before Sunday, September 30.


From Dr. Hamrahian's bio at



Amir Hamrahian, M.D. 

(216) 444-6568

Amir Hamrahian, M.D.

Appointed: 2000

Department:Endocrinology, Diabetes and Metabolism
Location:Cleveland Clinic Main Campus
Mail Code F20 
9500 Euclid Avenue
ClevelandOH 44195
Appointment:(216) 444-6568
Desk:(216) 445-8538
Fax:(216) 445-1656
Department:Brain Tumor and Neuro-Oncology Center
Location:Cleveland Clinic Main Campus
Mail Code R20 
9500 Euclid Avenue
ClevelandOH 44195
Appointment:(216) 444-6568
Desk:(216) 445-8538
Fax:(216) 445-1656
Adults Only

Research & Publications †

( † Disclaimer: This search is powered by PubMed, a service of the U.S. National Library of Medicine. PubMed is a third-party website with no affiliation with Cleveland Clinic.)

Biographical Sketch

Amir H. Hamrahian, MD, is a Staff member in the Department of Endocrinology, Diabetes and Metabolism at Cleveland Clinic's main campus, having accepted that appointment in 2005. Prior to that appointment, he was also a clinical associate there for nearly five years. 

His clinical interests include pituitary and adrenal disorders.

Dr. Hamrahian received his medical degree from Hacettepe University in Ankara, Turkey, and upon graduation was a general practitioner in the provinces of Hamadan and Tehran, Iran. He completed an internal medicine residency at the University of North Dakota, Fargo, and an endocrinology fellowship at Case Western Reserve University and University Hospitals, Cleveland.

In 2003, he received the Teacher of the Year award from Cleveland Clinic's Department of Endocrinology, Diabetes and Metabolism. Dr. Hamrahian speaks three languages -- English, Turkish and Farsi -- and is board-certified in internal medicine as well as endocrinology, diabetes and metabolism. He is a member of the Endocrine Society, Pituitary Society and the American Association of Clinical Endocrinologists.

Education & Fellowships

Fellowship - University Hospitals of Cleveland
Cleveland, OH USA
Residency - University of North Dakota Hospital
Internal Medicine
Fargo, ND USA
Medical School - Hacettepe University School of Medicine
Ankara Turkey


  • Internal Medicine
  • Internal Medicine- Endocrinology, Diabetes & Metabolism

Specialty Interests

Cushing syndrome, acromegaly, pheochromocytoma, prolactinoma, primary aldosteronism, pituitary disorders, adrenal tumor, adrenocortical carcinoma, MEN syndromes, adrenal disorders

Awards & Honors

  • Best Doctors in America, 2007-2008 


  • Pituitary Society
  • Endocrine Society
  • American Association of Clinical Endocrinologists
  • American Medical Association

Treatment & Services

  • Radioactive Iodine Treatment
  • Thyroid Aspiration
  • Thyroid Ultrasound

Specialty in Diseases and Conditions

Johns Hopkins Pituitary Patient Day, More Info

Johns Hopkins Pituitary Patient Day

Join us on Saturday, September 29, 2012, for the 4th Annual Patient Education Day at the Johns Hopkins Pituitary Center.

When: Saturday, September 29, 2012
Time: 9:30 a.m.
Johns Hopkins Mt. Washington Conference Center
5801 Smith Avenue
Baltimore, MD 21209
map and directions

Patient Education Day Agenda:
10:00 - 10:20 AM What is the pituitary, and what can go wrong Gary Wand, MD
10:25 - 10:45 AM Vision problems in pituitary patients Prem Subramanian, MD, PhD
10:50 - 11:10 AM Pituitary Disease: a patient’s prospective Barbara Craven, PhD
11:15 - 11:35 AM Surgery for Pituitary tumors: what to expect Alfredo Quinones-Hinojosa, MD and Gary Gallia, MD, PhD
11:40 - 12:00 PM Nose problems before and after pituitary surgery Masaru Ishii, MD, PhD
12:05 - 12:25 PM When is radiotherapy needed for pituitary tumors Kirsten Redmond, MD
12:30 - 1:25 PM Lunch
1:30 - 3:00 PM Breakout sessions
1) Medical therapy (Wand/Salvatori)
2) Surgical therapy (Gallia)
3) Radiation therapy (Redmond/Lim)
4) Vision issues (Subramanian)
5) Nose issues (Ishii)

*This schedule is subject to change

Please R.S.V.P. by September 14, 2012, by contacting Colleen Hickson at  (410) 614-5887

Reservations will be taken on a first-come, first-serve basis.

Monday, September 10, 2012

8th Annual Convention for Adults with Pituitary Disorders

The confirmed convention dates for the 8th Annual Convention for Adults with Pituitary Disorders are Friday, April 19th, 2013-Sunday, April 21st, 2013 in Las Vegas, NV. 


So far, they are looking at two hotels, either the SUNCOAST or TUSCANY.


More info as it becomes available.

Friday, September 7, 2012

Fourth Annual Johns Hopkins Pituitary Patient Education Day

Saturday, September 29, 2012

9:30AM Registration

10:00AM Presentations

12:30 PM Lunch

1:30-3:00PM Breakout sessions with physicians

Johns Hopkins Mt Washington Conference Center

5801 Smith Avenue

Baltimore, MD 21209


Please RSVP by September 14, 2012

Colleen Hickson at or 410.614.5887