What would Harvey Cushing say about Cushing’s disease today?

(BPT) - More than 80 years ago renowned neurosurgeon, Dr. Harvey Cushing, discovered a tumor on the pituitary gland as the cause of a serious, hormone disorder that leads to dramatic physical changes in the body in addition to life-threatening health concerns. The discovery was so profound it came to be known as Cushing’s disease. While much has been learned about Cushing’s disease since the 1930s, awareness of this rare pituitary condition is still low and people often struggle for years before finding the right diagnosis.

Read on to meet the man behind the discovery and get his perspective on the present state of Cushing’s disease.

* What would Harvey Cushing say about the time it takes for people with Cushing’s disease to receive an accurate diagnosis?

Cushing’s disease still takes too long to diagnose!

Despite advances in modern technology, the time to diagnosis for a person with Cushing’s disease is on average six years. This is partly due to the fact that symptoms, which may include facial rounding, thin skin and easy bruising, excess body and facial hair and central obesity, can be easily mistaken for other conditions. Further awareness of the disease is needed as early diagnosis has the potential to lead to a more favorable outcome for people with the condition.

* What would Harvey Cushing say about the advances made in how the disease is diagnosed?

Significant progress has been made as several options are now available for physicians to use in diagnosing Cushing’s disease.

In addition to routine blood work and urine testing, health care professionals are now also able to test for biochemical markers - molecules that are found in certain parts of the body including blood and urine and can help to identify the presence of a disease or condition.

* What would Harvey Cushing say about disease management for those with Cushing’s disease today?

Patients now have choices but more research is still needed.

There are a variety of disease management options for those living with Cushing’s disease today. The first line and most common management approach for Cushing’s disease is the surgical removal of the tumor. However, there are other management options, such as medication and radiation that may be considered for patients when surgery is not appropriate or effective.

* What would Harvey Cushing say about the importance of ongoing monitoring in patients with Cushing’s disease?

Routine check-ups and ongoing monitoring are key to successfully managing Cushing’s disease.

The same tests used in diagnosing Cushing’s disease, along with imaging tests and clinical suspicion, are used to assess patients’ hormone levels and monitor for signs and symptoms of a relapse. Unfortunately, more than a third of patients experience a relapse in the condition so even patients who have been surgically treated require careful long-term follow up.

* What would Harvey Cushing say about Cushing’s disease patient care?

Cushing’s disease is complex and the best approach for patients is a multidisciplinary team of health care professionals working together guiding patient care.

Whereas years ago patients may have only worked with a neurosurgeon, today patients are typically treated by a variety of health care professionals including endocrinologists, neurologists, radiologists, mental health professionals and nurses. We are much more aware of the psychosocial impact of Cushing’s disease and patients now have access to mental health professionals, literature, patient advocacy groups and support groups to help them manage the emotional aspects of the disease.

Learn More

Novartis is committed to helping transform the care of rare pituitary conditions and bringing meaningful solutions to people living with Cushing’s disease. Recognizing the need for increased awareness, Novartis developed the “What Would Harvey Cushing Say?” educational initiative that provides hypothetical responses from Dr. Cushing about various aspects of Cushing’s disease management based on the Endocrine Society’s Clinical Guidelines.

For more information about Cushing’s disease, visit www.CushingsDisease.com or watch educational Cushing’s disease videos on the Novartis YouTube channel at www.youtube.com/Novartis.

From http://www.jsonline.com/sponsoredarticles/health-wellness/what-would-harvey-cushing-say-about-cushings-disease-today8087390508-253383751.html

Newest Cushing's Helpful Doctors

• Richard J. Auchus, M.D., Ph.D., info updated (Ann Arbor, Michigan)
• Dr. Maria Falcone (endo) (South Bend, Indiana)
• Dr. Cargill Alleyne-Augusta, GA 2012 Best Doctors
• Updated Dr. C.L. Chik (Edmonton, Alberta, Canada)
• Updated: Maryland: Johns Hopkins Pituitary Tumor Center
• Dr. Carlos M. Isales (Atlanta, Georgia)
• Dr. Jyothi Joseph-Hayes (Orlando, Florida)
• Dr. David S. Baskin (Neurosurgeon) (Houston, Texas)

Find them all (or add your own) here: Cushing's Helpful Doctors

Dr. Cargill Alleyne - Augusta, GA 2012 Best Doctors

Dr. Cargill Alleyne

Neurosurgeon

You’re going to work hard whatever you do, so work hard doing something you love,” says Dr. Cargill Alleyne, director of the neurosurgery residency program at Georgia Health Sciences University, among other professional appointments. Research, instruction, publishing, inventing and clinical practice stimulate, invigorate and energize him. “When you’re in the operating room, you’re dedicating all your energies, all your senses, to one specific problem and time flies,” he says. That experience of flow along with the element of human interaction drew him to medicine and specifically to neurosurgery.

His unique ability to be in the moment, tending to each patient one-on-one and, at the same time, to consider the bigger picture and how he can contribute to it distinguishes his approach to medicine. The model for his own career and his message to the neurosurgeons he teaches is this: Perform one surgery and change a single life. Teach another person to perform that surgery, change several lives. Conduct research and publish results and broaden the scope of impact by reaching practitioners around the world. Improve a current procedure or implement a new treatment paradigm and influence the healing of future generations of patients. Every element of this model supports a philosophy of providing the best care possible at the personal level and ensuring that every person receives the best care possible.

The brain is the last frontier, rife with the potential for specialties and sub-specialties. Despite technological advances made since Dr. Harvey Cushing (1869-1939), the undisputed Father of Neurosurgery, pioneered effective operations, the organ of the brain still holds many mysteries. Young residents, believes Dr. Alleyne, have the advantage of flexible thinking and, thus, possess the power to not just practice neurosurgery competently, but to improve it.

Interestingly, Dr. Alleyne has combined his love of Hollywood productions, his interest in medical history and his professional training in neurosurgery to write a screenplay, Hands of Gold, Feet of Clay–The Harvey Cushing Story, which won 13th place at the 2006 FilmMakers International Screenwriting Awards. Though he very humbly says, “It was something to do,” the project required extensive reading and research and took a year to complete. A collection of coincidences suggests that perhaps it was more than something to do; it was something he was meant to do. For example, Cushing, incidentally, had a brother named Alleyne. Cushing and Dr. Alleyne both attended Yale. And the Cushing Tumor Registry, a collection of glass jars containing brain tissues from Cushing’s many surgeries, was stored in the basement of the building in which Dr. Alleyne lived during medical school at Yale.

Neurosurgeons dedicate six to seven years beyond medical school to honing their craft. They perfect technically precise procedures. Many lose themselves in their careers. Cushing performed more than 2,000 brain surgeries and recorded volumes of detailed notes and illustrations, advancing successful treatment methods but spending little time with his wife and five children. Dr. Alleyne shares Cushing’s commitment. Yet, he also values building a strong family with his wife Audrey and their children, Nicole, 10, and Nathan, 12. Working hard at what he loves energizes him for the ones he loves.

Read more at Augusta Magazine

Pituitary Surgery Video

From UCLAHealth on Jun 14, 2011

 

Arizona, Tucson: New center at UMC to treat tough brain tumors

He's known as the neurosurgeon who successfully operated on U.S. Rep. Gabrielle Giffords after she was shot in the head, but Dr. G. Michael Lemole Jr. is building a reputation in an entirely different area of brain surgery - removing hard-to-reach tumors through the nose.

Lemole and an ear, nose and throat surgeon at Tucson's University Medical Center have established a new center for benign and malignant tumors that occur in the sinus cavities and at the base of the brain. Among other things distinguishing the center is the surgeons' ability to remove large tumors like craniopharyngiomas through the nose, eliminating a need to open up the skull.

Rather than using a microscope as surgeons have done in the past for such surgeries, Lemole uses an instrument called an endoscope, which allows a broader view inside the brain. It's like the difference between looking at a room through a keyhole versus opening the door and getting a panoramic view, he said.

"It's not that through-the-nose surgery is new. It's the new tools and expertise that allow us to put the camera right up front and center at the pituitary level or wherever the target is," Lemole said. "And with those special tools, we're able to reach around corners, and this allows us to take out tumors that we couldn't in the past."

Tumors at the base of the skull are particularly difficult, he said in a recent interview, pulling out a model of a brain and pointing to one section in the bottom.

"Just down here, just in this little tight area, you have the nerves for your hearing, for your facial strength, the nerves for sensation over your face and, of course, your brain stem, which is critical to passing all the information from the brain all the way down the spinal cord. So I have to work in a very tight space and if I have a large tumor that is wrapping around all the structures, it becomes much more complex."

Of about 3,000 board-certified neurosurgeons in the country, only 200 or so specialize in skull-base tumors.

With the advanced technology of the endoscope and using a technique of breaking the tumor down called debulking, they are able to remove tumors through patients' nasal passages.

Lemole and UMC's otolaryngology division chief Dr. Alexander G. Chiu have done about 15 of the minimally invasive nasal surgeries together since establishing the local Center for Sinonasal and Skull Base Tumors four months ago.

Benign pituitary tumors are the most common, but they've also done surgeries together to remove craniopharyngiomas, as well as benign and malignant sinus tumors. They hope to do at least 100 such minimally invasive surgeries per year.

Lemole and Chiu hope their center, unique for its collaboration in an academic setting, will attract patients from across the Southwestern U.S. and eventually become a medical tourism destination for people from other parts of the country and even the world.

They say the key to the center is teamwork. Most neurosurgeons aren't comfortable operating on tumors when they move into the eye orbit or into the nasal space - it's beyond where they typically go. That's where having a specialist like Chiu as reinforcement is a tremendous help.

"Your nose and your sinuses border your brain. So a lot of the tumors that go from the nose can actually go up into the brain," Chiu said. "And a lot of the tumors at the base of the brain can actually hang down into the nose."

Traditionally, to remove a sinus tumor, surgeons would split a patient's lip and pull the face aside.

"You'd be left with a big scar," Chiu said.

The nasal surgeries often take much longer than when the skull is opened up, but the surgery is still more advantageous to the patient, the doctors say.

One of the center's first patients was 49-year-old Tucson aircraft mechanic Eugene Vasquez. The father of three and grandfather of four had a growing brain tumor that he said looked like a peach. It was pressing on his eyes, causing double vision, dizziness and headaches. The whole left side of his face eventually went numb. He'd first been diagnosed in September 2009 when he went to a local emergency room for what he thought was a sinus infection. He was told there might be nothing that could be done.

"It scared the crap out of me," said Vasquez, who had the tumor removed through his nose by Chiu and Lemole Nov. 20. He was released from UMC on Thanksgiving and went back to work a month later. "I got lucky. I was blessed that Dr. Chiu got here at the right time."

Chiu came to Tucson from a 1,000-bed hospital at the University of Pennsylvania six months ago. While UMC, at 487 beds, is less than half the size of the hospital he came from, Chiu said establishing a Center for Sinonasal and Skull Base Tumors in Tucson was an opportunity he wanted to pursue. And working with Lemole, who operated a skull-base tumor center at the University of Illinois in Chicago, was a big part of the reason he took the job, he said. Lemole moved from Chicago to Tucson to become chief of neurosurgery at UMC in October 2009.

Vasquez's tumor was benign, but the terms "benign" and "malignant" can be misleading when it comes to brain growths. Many benign tumors are fatal because of the damage they cause to critical parts of the brain. Chiu told Vasquez his tumor was dangerously large and performed the surgery almost immediately after seeing him.

"When things go beautifully and everything goes well, it's very common for patients to not feel like they've had much surgery," Chiu said. "The biggest advantage we have is that patients will spend a lot less time in the hospital and have a lot less pain."

Not all patients qualify for the surgery. A glioma, for example, would be too high in the brain to qualify. "It has to be at the bottom of the brain so that we can access it through the nose," Chiu said. Such tumors are rare and affect less than 1 percent of the population, Lemole said.

Lemole stressed that the center he's established with Chiu is not solely about removing tumors through the nose. It's about treating all tumors at the base of the skull, he said. The center also works with plastic surgeons, oculoplastic surgeons, radiology, radiation oncology, endocrinologists and neurologists.

"It's a multidisciplinary group," he said. "If the patient needs the minimally invasive approach and we can offer that, we'd love to. If they need the maximally invasive approach where we literally take down their face or take down their skulls in the old traditional ways, we can do that, too."

Lemole still performs trauma surgeries like he did Jan. 8, the day of Tucson's mass shootings, but the skull-base work now comprises most of what he does.

On StarNet: Stephanie Innes brings you the latest health information in her blog, Tucson Health and Wellness, at go.azstarnet.com/health

Reporter Stephanie Innes is at sinnes@azstarnet.com

From http://azstarnet.com/news/science/health-med-fit/article_64800a3e-9389-563f-9854-44089944cffa.html

Diagnosed for obesity surgery in the US, 35 year Old American Lady weighing 136 kg was correctly detected of brain tumor

In the unique case which will strengthen the confidence of the World in the abilities of Indian doctors, team of specialist Fortis Hospitals Mulund correctly diagnosed and treated a 35 year old US national Ms Michelle Hardin of brain tumor. The US doctors had earlier diagnosed the condition as a case of obesity and recommended Gastric Bypass Surgery.

click to learn more

In the last few years Ms Hardin’s weight increased from 190 pounds to 300 pounds (86 kg to 136 kg). She also suffered from diabetes and hypertension. “I tried various diet control measures but to no avail. Also I had excessive thirst and would drink almost 8 liter of liquid daily and would feel always hungry. My obesity caused breathing difficulty (sleep apnea) and for which I used a special machine (CPAP Machine) to keep oxygen under pressure. Seven months back I took an expert opinion in US, where I was asked to undergo Gastric Bypass Surgery (GBS) to treat obesity. Since GBS was very expensive in US, I thought of undergoing the treatment in India.” Ms Hardin

Ms Hardin decided to visit Fortis Hospital to consult Dr Ramen Goel who has a vast experience of performing thousands of advanced laparoscopic surgeries including bariatric surgeries.

“Ms Hardin visited us with the known fact that she had to undergo Bariatric surgery through Gastric Bypass method. Detailed investigations at the hospital however revealed that she actually had a Pituitary Tumor on the right side of the pituitary gland of about 1cm in diameter. The weight gained was actually because of this pituitary tumour and not because of any case of obesity. I referred her to Dr Milind Vaidya, Consultant Neurosurgeon who has an expertise to remove the tumour through minimally invasive procedure.” said Dr Ramen Goel.

Dr. Milind Vaidya, Consultant Neurosurgeon, Fortis Hospitals Mulund said, “The tumor, situated in pituitary gland at the base of the brain, triggered excessive production of cortisol hormone by the adrenal glands leading to complications like uncontrolled diabetes, hypertension and weight gain. We treated her by transnasal- transsphenoidal excision of the pituitary tumor (a minimally invasive procedure) on 14th Jan 2011.”

Dr Vaidya used an endoscope & microscope to reach the tumour through her nostrils. He used both the nasal openings to reach the tumour to avoid incision or scar. He took special care to remove every bit of the tumour, to achieve cure and preserve the normal pituitary gland.

Ms Hardin had an uneventful excision of the right sided tumor and the normal pituitary on the left side was left untouched. Her nasal pack has been removed and she is doing well post-operation, with diabetes & hypertension under good control.

“I was shocked to learn that I suffered from tumour. I thank the doctors of Fortis Hospital. Had there been no timely intervention from them I wouldn’t know what would have happened to my life. Post operative my thirst & appetite have reduced markedly to normal levels. Doctor assured that my weight will be restored to normalcy gradually.” Ms Hardin.

According to Dr Vaidya, “Ms Hardin’s life is today safe and secure only because of timely detection. Had we continued the treatment of GBS or had we wrongly diagnosed the case, her condition could have been critical. Hence timely detection and right expertise is very crucial. This case is a testimony to the quality and credibility of Indian Healthcare expertise.”

Today India is considered as the best treatment destination by foreign patients as they can avail the finest medical facilities at affordable rates. Fortis has partnered with Indushealth in the US who has played a significant role in helping many such international medical travelers avail quality healthcare services at Fortis.

From http://fortishospitals.wordpress.com/2011/01/25/diagnosed-for-obesity-surgery-in-the-us-35-year-old-american-lady-weighing-136-kg-was-correctly-detected-of-brain-tumor-at-fortis-hospitals-mulund/

UK guidelines for the management of pituitary apoplexy

Authors: Rajasekaran, Senthil¹; Vanderpump, Mark²; Baldeweg, Stephanie³; Drake, Will⁴; Reddy, Narendra¹; Lanyon, Marian⁵; Markey, Andrew⁶; Plant, Gordon⁵; Powell, Michael⁷; Sinha, Saurabh⁸; Wass, John⁹

Source: Clinical Endocrinology, Volume 74, Number 1, January 2011 , pp. 9-20(12)

Publisher: Wiley-Blackwell

Abstract:

Summary

Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe life saving. It is a clinical syndrome characterized by the sudden onset of headache, vomiting, visual impairment and decreased consciousness caused by haemorrhage and/or infarction of the pituitary gland. It is associated with the sudden onset of headache accompanied or not by neurological symptoms involving the second, third, fourth and sixth cranial nerves. If diagnosed patients should be referred to a multidisciplinary team comprising, amongst others, a neurosurgeon and an endocrinologist. Apart from patients with worsening neurological symptoms in whom surgery is indicated, it is unclear currently for the majority of patients whether conservative or surgical management carries the best outcome. Post apoplexy, there needs to be careful monitoring for recurrence of tumour growth. It is suggested that further trials be carried out into the management of pituitary apoplexy to optimize treatment.

Document Type: Research article

DOI: 10.1111/j.1365-2265.2010.03913.x

Affiliations: 1: Churchill Hospital, Oxford 2: Royal Free Hospital, London 3: University College Hospital, London and Trustee and member of the Medical Committee -The Pituitary Foundation 4: St. Bartholomew's Hospital, London and Society for Endocrinology 5: University College Hospital, London 6: The Lister Hospital, London 7: National Hospital for Neurology, London and Society of British Neurosurgeons 8: Royal Hallamshire Hospital, Sheffield 9: Churchill Hospital, Oxford and Royal College of Physicians

From http://www.ingentaconnect.com/content/bsc/cend/2011/00000074/00000001/art00002

Pituitary disorders may affect as many as 20 percent of the population

 

Denise Dador
More: Bio, E-mail, Facebook, Home Page, News Team

LOS ANGELES (KABC) -- Researchers believe there may be millions of people with unexplained symptoms who are being misdiagnosed. Doctors say problems with the brain's pituitary gland are more common than most people think.

Many of us suffer from fatigue, headaches, infertility and weight gain. Most of us would never think those symptoms could possibly add up to a brain tumor.

Pituitary disorders may affect as many as 20 percent of the population. And the signs are often quite difficult to discern.

We all have trouble seeing as we age, but within a few months Tom Lobl's vision practically deteriorated sharply.

"I was seeing double vision. Letters were disappearing, and I was having trouble reading signs on the street when I was driving," said Lobl.

An eye doctor prescribed glasses, but it just kept getting worse. Then ...

"An MRI found the tumor," said Lobl. A non-cancerous brain tumor growing on his pituitary gland. It so big it was squishing the gland into a sliver.

"There are probably many people that are walking around that have abnormalities in the pituitary gland that we don't know about," said Dr. Daniel Kelly.

Neurosurgeon Dr. Daniel Kelly at Saint John's Health Center says Lobl probably had this tumor for 10 years. Often the symptoms are misdiagnosed.

"Many of the men we see that have low libido from low testosterone they may simply be treated with Viagra because no one bothered to test the testosterone level," said Kelly.

The pituitary gland may weigh less than a gram but doctors call it the "master gland" because it controls so many aspects of life. It's affects metabolism, reproductive function and your response to stress.

If left untreated: "They can have what's called an 'adrenal crisis.' Because the pituitary stops making the critical stress hormone," said Kelly.

A blood test can tell if something is going on with the pituitary gland. Patients can be treated with medication, but Lobl needed surgery.

Dr. Kelly enters the pituitary cavity through the nose. Using endoscopic tools he can remove the tumor without any scarring or cutting through key structures in the skull.

Within a few days, Lobl was up and about. Now, 15 months after surgery, he feels like a new person.

"I'm back to my normal activities and strength," said Lobl. "I feel a lot younger than I did. The tumor made me feel old."

Endonasal surgery to remove a pituitary tumor does have potential complications such as stroke and blood clots. But Dr. Kelly says the chances are less than 1 percent.

Kids can present with pituitary tumors, but it mostly occurs in adults. The age range is usually between 20 and 80 years old.

http://abclocal.go.com/kabc/story?section=news%2Fhealth%2Fyour_health&id=7765964