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Location of the pituitary gland in the human brain (Photo credit: Wikipedia)

“Got headache? Take a paracetamol and get relieved in a short while.”

This is common practice in our country. Almost everyone has had a headache, but rarely headache becomes a headache in our lives. Not all headaches require doctor’s attention but sometimes it represent the tip of a huge iceberg.

Mr Shafiul Islam, 38 years of age, an active male developed a gradual onset of headache, which worsened at the morning, followed by vomiting. He visited a general practitioner and took prescribed medicines, but that failed to cure the symptoms. Rather he was gradually experiencing loss of outer side vision of both eyes.

When he revisited a doctor and was advised for MRI of brain he was diagnosed with a core of “Pituitary Macrodenoma,” a tumor of a hormone producing gland of brain. Then Shafiul was referred to Neurosurgeon of Comfort Nursing home Assistant Professor Dr Moshiur Rahman, who decided to perform operation for removal of the tumor after the initial evaluation.

The pituitary gland is an endocrine gland about the size of a pea and weighing 5 grams (0.18 oz) in humans. It is a protrusion off the bottom of the hypothalamus at the base of the brain, and rests in a small, bony cavity (sella turcica). The pituitary gland secretes nine hormones. A pituitary adenoma is a slow growing and less harmful tumor arising from cells in the pituitary gland. Because they originate from cells in the pituitary gland, which is the master hormone gland, they often cause problems related to hormonal dysfunction.

Some pituitary tumors result in excessive production and over-secretion of hormones, which can result in a variety of syndromes. A large proportion of these tumors, however, do not produce any functional hormones, but instead grow to a size where they cause symptoms because they compress surrounding structures. For these reasons, larger pituitary tumors (called macroadenomas) often present with headache, visual loss and pituitary gland dysfunction.

The specific cause of pituitary adenoma development is unknown, although they are likely to be caused in part by random mutations in cells of the pituitary gland. Surgery is the first line of treatment for many symptomatic pituitary tumors in patients that are good surgical candidates, especially in patients with nonfunctioning macroadenomas.

Dr Moshiur approached the tumor by entering through nasal opening with the help of ENT specialist Associate Professor Dr Sajol Ashfaq, under general aenesthesia (fully unconscious) done by Aenesthesiologist Associate Professor Dr Shamsul Alam. After elevation of a thin membrane over the nasal partition and breaking a bone in the base of the skull they got a vision of the tumor through endoscope. After that, the tumor was removed through the nose. After three days of post-operative care, the patient was discharged. All his symptoms, headache, vomiting and poor vision improved dramatically and he got back to his normal life.

Dr Moshiur Rahman said: “The surgical approach for removing pituitary tumours is usually an endonasal (through the nostril) transsphenoidal (through the sphenoid sinus) approach. This procedure is Endoscopic Transnasal Transphenoidal Pituitary Adenomectomy, which is a safe, minimally invasive but effective, modern treatment option for Pituitary Adenoma, with few side effects and short post-operative hospital stay. This latest technology is being practiced in some centres of the capital for last few years.”

He also said, he performed three operations before successfully with no long term adverse effect. He also paid gratefulness to Associate Professor Dr Sajol Ashfaq and Associate Professor Dr Shamsul Alam for their sincere and great effort.

Once, people had to go outside of the country for this operation. Nowadays, this operation is often performed by many neurosurgeons of the capital. A few centres have also developed to provide these facilities of operation. People can take this oppurtunity confidently by choosing a competent surgical team.

Filed under: pituitary | Tagged: endonasal, headache, macroadenomas, Magnetic resonance imaging, MRI, Neurosurgery, Pituitary adenoma, Pituitary gland, surgery, transsphenoidal, tumor | 1 Comment »