Shortly after the birth of her twins, a vision problem brought Sally to Dr. Kaushal Kulkarni, one of a few neuro-ophthalmologists practicing at Sharp Rees-Stealy Medical Center in San Diego. The diagnosis of a pituitary gland tumor brought in Sharp-affiliated neurosurgeon Dr. Vikram Udani to perform a life-changing, high-tech brain surgery at Sharp Grossmont Hospital.
We asked Drs. Kulkarni and Udani about Sally’s case and to explain the kind of tumor this new mother developed, and how they were able to remove the tumor surgically using advanced technology.
What is a pituitary adenoma?
Dr. Udani: A pituitary adenoma is a tumor arising from the pituitary gland at the base of the skull. Sometimes these tumors are diagnosed because they secrete excessive amounts of hormones. Depending on which hormone is secreted, patients can experience unusual symptoms like unexpected lactation, increased hand size or purplish abdominal stretch marks. Other times, compression on the optic nerves can affect a patient’s vision, as in Sally’s case.
How unique is a case like Sally’s?
Dr. Udani: Pituitary tumors make up one-third of all primary brain tumors. Approximately 10,000 pituitary tumors are diagnosed in the U.S. each year, with women being slightly more affected than men are.
How common is it to find a pituitary adenoma in someone who is pregnant?
Dr. Kulkarni: The pituitary gland increases in size up to about 30 percent in a normal pregnancy, but this does not cause any problems in the majority of cases. Sally probably already had an underlying pituitary tumor before she became pregnant, and the increase in size during the pregnancy is what set off her symptoms.
Did you know the tumor was benign before you went in to remove it?
Dr. Udani: Pituitary tumors are usually benign, which means they won’t spread to other parts of the brain. However, if they are not removed, they can continue to grow and compress the optic nerves, leading to blindness, or compress the brainstem, leading to death.
How large was Sally’s tumor? How was it removed?
Dr. Udani: Sally’s tumor was roughly 2 centimeters in diameter, which is the size of a marble. These tumors used to have to be removed by making large openings in the skull and working underneath the brain, which can be risky. Now, surgery takes an hour and is done through the nostril by making a small opening in the bone at the base of the skull. This is due to advancements in microscopy, endoscopy and imaging. This particular surgery is now very safe and has a short post-operative hospital stay.
Will Sally now have to undergo annual MRIs to check for other tumors?
Dr. Udani: Now that her tumor has been removed, Sally will continue to have MRI scans every six to 12 months to make sure there is no recurrence, which is rare but possible. Sally is not pre-disposed to other types of tumors in the brain. Pituitary tumors are sporadic, and as of now, she’s cured.
Dr. Kulkarni: As an eye doctor, I actually prefer to monitor her visual fields for any signs of recurrence, since this is much easier to do in the office. It will show me if there are any signs of recurrence of the tumor.
Any final thoughts?
Dr. Udani: Treating Sally has been a privilege. She is completely dedicated to her twin daughters and is a wonderful mother. Having her vision restored to 100 percent normal is one of the most satisfying feelings as a neurosurgeon.
Dr. Kulkarni: Sally’s case is a good reminder that despite the amazing technology that we have in the miracle of modern medicine, the basic principles of listening to the patient’s story and doing a good physical examination are still — to this day — the most important tools that we have as doctors.