Neurosurgeon and Otolaryngologist Team Up to Remove Tumor in Pituitary Gland

After experiencing bad headaches and double vision, Kris Johnson was diagnosed with a pituitary adenoma, a tumor of the pituitary gland at the base of the brain. Loyola ENT surgeon Chirag Patel, MD, teamed up with neurosurgeon Anand Germanwala, MD, to remove the tumor, and Ms. Johnson now is “100 percent back to normal.”

Article ID: 668877

Released: 3-Feb-2017 2:05 PM EST

Source Newsroom: Loyola University Health System

Pituitary Dysfunction as a Result of Traumatic Brain Injury

A victim of brain injury can experience many consequences and complications as a result of brain damage. Unfortunately, the problems caused by a traumatic brain injury can extend even beyond what most people think of as the standard symptoms of a brain injury, like mood change and cognitive impairment. One issue which can occur is pituitary dysfunction. If the pituitary gland is damaged due to injury to the brain, the consequences can be dramatic as the pituitary gland works together with the hypothalamus to control every hormonal aspect of a person’s body.

Pituitary dysfunction as a result of a brain injury can be difficult to diagnose, as you may not immediately connect your symptoms to the head injury you experienced. If you did suffer injury to the pituitary gland, you need to know about it so you can get proper treatment. If someone else caused your brain injury to occur, you also want to know about your pituitary dysfunction so you can receive compensation for costs and losses associated with this serious health problem.

The pituitary is a small area of the center of your brain that is about the size of the uvula. The pituitary is surrounded and guarded by bone, but it does hang down.  When it becomes damaged as a result of a brain injury, the damage normally occurs as a result of the fact the pituitary was affected by reduced by reduced blood flow. It can also be harmed directly from the trauma, and only a tiny amount of damage can cause profound consequences.

Many of the important hormones that your body needs are controlled by the pituitary working with the hypothalamus. If the pituitary is damaged, the result can include a deficiency of Human Growth Hormone (HGH). This deficiency can affect your heart and can impact bone development.  Thyroid Stimulating Hormone (TSH) can also be affected, which could result in hypothyroidism. Sex hormones (gonodotropin); Adrenocorticotopic hormone; and many other hormones could be impacted as well, causing fertility problems; muscle loss; sexual dysfunction; kidney problems; fatigue; or even death.

Unfortunately, problems with the pituitary gland may not always be visible on MRIs or other imaging tests because the pituitary is so small. Endocrinologists who handle hormone therapy frequently are not familiar with brain injuries, and may not make the connection that your brain injury was the cause of the problem.

If you begin to experience hormonal issues following an accident, you should be certain to get an accurate diagnosis to determine if your brain injury played a role. If it did, those responsible for causing the accident could be responsible for compensating you for the harm you have experienced to your pituitary and to the body systems which malfunction as a result of your new hormonal issues.

Nelson Blair Langer Engle, PLLC

From http://www.nblelaw.com/posts/pituitary-dysfunction-result-of-traumatic-brain-injury

Effects of Cushing’s syndrome on the human brain

Cushing’s syndrome (CS) is characterized by excessive exposure to cortisol, and is associated with both metabolic and behavioural abnormalities even after biochemical cure. Andela et al conducted a systematic review of literature available in the PubMed, Embase, Web of Knowledge, and Cochrane databases evaluating structural and functional changes in the brain identified by magnetic resonance imaging in CS patients. They also reviewed potential associations between brain characteristics and disease status, cognitive functioning, psychopathology, and general well-being.

They found CS has profound effects on the human brain including abnormalities in structural grey matter, possibly white matter and neurochemical and functional alterations. After correction of hypercortisolism, the structural and neurochemical alterations improve substantially and correlate with improvements in clinical and behavioural outcomes. Nevertheless, abnormalities in both grey- and white matter are not completely reversible at long-term remission and are accompanied by psychological symptoms and impairments in cognitive functioning.

The full review by Andela et al. is published in the European Journal of Endocrinology 2015 173DOI:10.1530/EJE-14-1101

From http://www.ese-hormones.org/news/article.aspx?articleid=9306

Mutation of ARMC5 gene characterized as the cause of meningeal tumour growth

Scientists at the Luxembourg Centre for Systems Biomedicine (LCSB) of the University of Luxembourg have published their findings that mutations in a gene known as “ARMC5” promote the growth of benign tumours in the adrenal glands and on the meninges: ARMC5 appears to belong to the group of so-called tumour suppressor genes. It is the first time in years that scientists have characterized such a gene.

The ARMC5 gene was discovered by independent workgroups studying – so-called adrenal adenomas – in connection with Cushing’s syndrome. In this disease, the body produces too much of the . Now, for the first time, a mutation of ARMC5 has been characterized as the cause behind the growth of meningeal tumours. The results on this tumour syndrome, obtained by the group of Dr. Patrick May and PD. Dr. Jochen Schneider together with colleagues from Charité Berlin (Dr. Ulf Elbelt) and the Universities of Würzburg (Prof. Dr. Bruno Allolio) and Cologne (Dr. Michael Kloth), have been published recently in the Journal of Clinical Endocrinology Metabolism.

Cortisol is an important hormone. It influences many metabolic pathways in the body and has a suppressing effect on the immune system. Accordingly, it is commonly employed as an anti-inflammatory medication. Prolonged, elevated levels of cortisol in the body can lead to obesity, muscular dystrophy, depression and other symptoms. To maintain the correct concentration in the blood, the body has a refined regulation system: Certain areas of the brain produce the hormone corticotropin as a stimulator of cortisol release; the actual formation of cortisol takes place in the . As the concentration of cortisol in the blood rises, the brain reduces the production of corticotropin.

In search of the causes of Cushing’s syndrome, scientists recently encountered certain genetic causes of benign tumours of the adrenal cortex. Growth of these adrenal cortex adenomas is based on a combination of hereditary and spontaneous mutations: It affects people in whom one of two “alternative copies” – one of the so-called alleles – of the ARMC5 gene is mutated from birth. If the second allele of ARMC5 later also undergoes a spontaneous mutation in the adrenal cortex, then the gene no longer functions. “What is interesting is that the failure of ARMC5 has no direct influence on cortisol production. However, because the tumour cells multiply faster than other body cells, and the number of cells in the tumour increases, the blood cortisol level rises in the course of the disease”, says Dr Schneider. Then, the level in the body rises and ultimately results in the onset of Cushing’s syndrome.

When other scientific workgroups discovered that further benign tumours – in this case meningeal tumours – occur more often in ARMC5-Cushing families, the group of Patrick May and Jochen Schneider sequenced the ARMC5 gene and studied it using bioinformatic techniques. “We demonstrated for the first time, in a patient with an adrenal cortex tumour and simultaneously a meningeal tumour, that somatic, that is non-hereditary, ARMC5 mutations are present in both tumours. This observation suggests that ARMC5 is a true tumour-suppressor gene.”

It must now be explored, Schneider continues, to what extent patients with adrenal cortex tumours ought to be screened for simultaneous presence of meningioma, and in which other types of tumour ARMC5 mutations are responsible for tumour growth: “Building upon that, we can learn whether the gene and the metabolic pathways it influences offer new approaches for treating the tumour syndrome.”

More information: “Molecular and Clinical Evidence for an ARMC5 Tumor Syndrome: Concurrent Inactivating Germline and Somatic Mutations are Associated with both Primary Macronodular Adrenal Hyperplasia and Meningioma.” Journal of Clinical Endocrinology Metabolism, October 2014. DOI: 10.1210/jc.2014-2648

Journal reference: Journal of Clinical Endocrinology & Metabolism search and more info website

Provided by University of Luxembourg search and more info

From http://medicalxpress.com/news/2014-10-mutation-armc5-gene-characterized-meningeal.html

Brains in jars at the Cushing Center in the Yale Medical Library

harvey-cushing-memorial

Sitting quietly in jars in a custom-built room at Yale’s medical library are 550 human brains. The collection once belonged to pioneering neurosurgeon Harvey Cushing, who preserved the brains from 1903 to 1932 as part of his tumor registry. When Cushing died in 1939, his undergraduate alma mater Yale inherited the brains.

Cushing was among a handful of doctors operating on the brain during the early 20th century. At the time, about a third of patients who underwent brain tumor surgery did not survive the operation. Cushing introduced practices that dramatically lowered the mortality rate, such as monitoring blood pressure during surgery and operating with a local anesthesic instead of ether. He was also the first to use x-rays to diagnose brain tumors.

 

Read the entire article here: Brains in jars at the Cushing Center in the Yale Medical Library.

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