Pituitary Awareness Quiz: Day 2

Welcome to today's question about the pituitary gland! Yesterday's question was relatively easy to Google, so I thought I'd throw in a slightly more tricky one for you (and my boyfriend did the calculations!).

National Awareness Month Pituitary Awareness Quiz

Day 2 - Question 2

Q.2: Approximately how many (normal-sized) human pituitary glands could you fit in an Olympic-sized swimming pool?

a) 4 billion

b) 20 billion

c) 50 billion

d) 100 million

e) 100 billion

Anyone who provides workings to back up their answer will receive great respect. Good luck!

The (Im)Patient Patient

I've always had a problem with the phrase "caught like a rat in a trap". I feel it could be improved upon. Rats are smart. Rats, once caught, sometimes make it out of traps.

But they never make it out of cats.

I currently feel much like a rat in a cat. It has now been six weeks since I had an injection of lanreotide. They only last for a month. During that month I did feel much better. At one point I ran upstairs and my heartrate barely increased, even though I hadn't taken my medication that day. For me, that is a medial coup indeed.

Alas, those halcyon days are gone. I'm back to taking two or three propranolol tablets a day to keep my heartrate as normal as possible. My moments of hypoglycaemia (brought on by the lanreotide injections) have been replaced by finding the six flights of stairs to my desk much more challenging in the morning.*

As you can imagine, I am chafing under this new and irritating regime, rendered all the more irritating by the fact that if my stupid former GP's surgery didn't have such nonsensical rules then I would have had my second injection by now and all would be hunky dory. Consequently, I'm calling the hospital every week to find out what's going on. I contact one of the nurses in the endocrine department, who is lovely, and then we have a mutual guilt festival, whereby she feels guilty for not being able to give me good news and I feel guilty for making her feel guilty considering that it's not her fault in the slightest.

I called last Wednesday, at the five-weeks-since-last-injection mark, and the nurse said that she could confirm all the paperwork had finally been submitted, and she seemed optimistic that it would get approved quickly and I'd get the injection soon. I called again today but the atmosphere of optimism had sadly been replaced with uncertainty over exactly how long this would take. Apparently, if your life is not immediately threatened by the lack of medication, then it doesn’t matter that you're symptomatic and the tumour in your head could well be growing happily like an evil, greedy mushroom.** You just have to be patient.

If ever I had wondered how the word "patient" had come to have two such different meanings - meaning in the first instance, a calm endurance of difficulty, and in the second, a person receiving medical treatment - I stopped wondering some time ago, because it seems that extreme feats of patience are required pretty much as soon as you become a patient.


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*I should point out that my desk is in an office which is accessed by climbing six flights of stairs and then walking along a corridor. I don't just have a desk sitting atop a massive staircase, although that would be quite awesome.
** I don't like mushrooms.

Film of transphennoidal endoscopic surgery to remove a TSHoma

So while I don't wish to make everyone feel as nauseated as these injections sometimes make me, I found a film of transphennoidal endoscopic surgery to remove a TSHoma! How exciting! This is the type of surgery I will be having soon, probably around November time. The person whose head this was filmed inside is one of my fellow TSH-producing pituitary tumour brethren.

Don't be fooled, it doesn't actually just take six minutes. There's a whole lot of drilling down your nose required first.

Looks pretty simple to me. Well, I mean, it's not rocket science, is it?

The above is a) more suitable for an audience of a delicate disposition and b) one of my favourite Mitchell & Webb moments!

I Need More Surgery

I just had a phone call from the hospital and it's official: I'm going to be having more pituitary surgery. The results of the tests I had at the beginning of the month show that I'm still "thyrotoxic" as they call it (my thyroid hormone levels are too high) - which to be honest I could have told them myself, as I'm still having symptoms aplenty. The sad news though is that they think the pituitary tumour has grown since my previous MRI scan. My last scan was in March. For it to have noticeably grown in just three months is kind of worrying to me (and also makes me slightly more pissed off that they stopped my injections for four months when I was told it would be half that time - the tumour had been stable while I was on the injections...).

So, that sucks. I am reeeeeally not looking forward to more surgery. Last time I didn't know what to expect; this time I know exactly how many blood tests and needles and rubbish things will be involved, plus oh god when they take out the bandages from your nose! I believe it's slightly more risky the second time around, plus I'm going up against the same odds of ending up with diabetes inspidus/hypothyroidism/addisons disease/other pituitary fail.

I am also slightly concerned because I have had a slight sinus infection since last August thanks to the surgery and it just occurred to me that I don't know if they will even be able to operate unless they get rid of that first?

Here are the bright sides:
- Surgery at least carries with it the possibility of cure.
- I am marginally more in shape than I was last time around, so you never know - my crappy muscles might recover a little faster
- More time off work? (Admittedly, it's just time off to lie on the sofa complaining, but still)
- This time I will remember to ask about painkillers that I am not allergic to and am able to take.
- This time I will take photos in hospital and show them to YOU, dear reader.

So, here we go. Brain Surgery, Round 2!

Belated: Cushing's Disease Awareness Day

So it turns out that the 8th of April was Cushing's Disease Awareness Day, and I completely missed it. Not least because it was Easter Sunday, i.e. the first day I could eat chocolate again having given it up for Lent. It does seem cruelly ironic that the awareness day for a terrible disease, a key symptom of which is central obesity, should fall on a day that the rest of the world dedicates to filling their faces with fatty treats.*

Anyway, dedicated readers of my blog already know what Cushing's Disease is, but for everyone else: Cushing's Disease is caused by a tumour, known as an adenoma, on the pituitary gland. The tumour produces high levels of adrenocorticotropic hormone (ACTH) which can result in obesity, high sweating, hair loss, hypertension, diabetes, headaches, painful joints, and other not-so-fun symptoms. Treatment is chiefly through surgery and radiotherapy, as Cushing's is difficult to treat with medication.

There's a group of bloggers who suffer from Cushing's Disease who've been doing the "Cushing's Awareness Challenge", blogging on a different topic about their illness for every day of April. You can find out more about the challenge and read some of their blog posts by clicking here.

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*Well, I do anyway.

The Mysterious MRIs

So last night I headed back to the hospital for an MRI scan. As my appointment was at 7pm at night, I was unimpressed - not only because I didn't particularly want to spend my evening at the hospital, but also because I feared that if delays accumulated during the day, there would be an epic backlog of people waiting to be scanned.  Happily, my fears proved to be little more than paranoid ravings. Firstly my good friend Havana, who is a medical student, stayed late at the hospital to meet me and cooked a delicious chilli for us to share. And secondly, the entire MRI department was eerily deserted and I was ushered straight through for my scan.

Locating the department was the first problem, even though I have been there once before. Fortunately the signage was fairly good - although I was amused to discover that, despite having been a student at the hospital for a couple of years, Havana hadn't realised that the signs referred to the MRI department and not a mysterious organisation known only by the acronym M.R.I.S.

As we went along I realised that I had unwittingly committed a terrible libel against the hospital on this blog by accusing them in a previous post of keeping their MRI scanning service tucked away in a terrifying basement full of doors with signs saying things like "DO NOT ENTER: DANGER OF DEATH" and "COWER NOW, BRIEF MORTALS". This is not in fact the case. The MRI department is located in a pleasant and airy wing on the ground floor. It's actually the bone density unit that's in the terrifying basement.

But you can see how I might get confused; in the past two years I've been to quite a startling variety of different departments at the hospital, including:

Accident & Emergency (Good crisps in the vending machine)
Bone Density Unit (Terrifying basement)
Cardiology (I was the youngest patient by about half a century)
Endocrinology (TVs in the waiting area are always playing The Jeremy Kyle Show)
MRI Dept. (Easily confused with Bone Density Unit)
MRI/CT Dept. (Never actually had my CT scan in the end, so it was more of a day trip)
Neurosurgery (Why do they assume everyone having brain surgery wants to read Country Life?)
Opthalmology (Seething with human life; not enough seating)
Phlebotomy (Offer you tea if you nearly pass out)

So you can see how I get confused. Anyway: I was called in, took off all my metal and bundled it into a locker, then had to answer a set of questions designed to flag up any random bits of metal that might feasibly in my body. Almost a year after my operation, it still feels weird that the answer to the question "Have you had any form of brain or head surgery" is actually now "yes". I signed the consent form indicating that I'd not lied about my non-bionic status, and we went in.

I went in, took my shoes off and realised I'd made a terrible mistake. I was wearing slightly aged socks with holes in them.* Ladies and gentlemen, when you are going for an MRI scan it is imperative to wear good socks. They are the only part of you that is visible outside the machine. When the nurse comes in to give you an injection of contrast dye, they will judge you not on the content of your character, but by the colour of your socks. So wear nice ones.

Anyhow, I put in my earplugs, lay on the table and had the padding put in the MRI helmet and rolled backwards into the machine. I didn't feel at all claustrophobic this time, and I found it a lot easier to lie still, probably because I now have (hopefully) much lower levels of thyroid hormone sloshing around my body; previously I couldn't even keep my hands steady normally and was ultra jumpy, so expecting me to be able to lie completely still while sudden loud noises went off all around me was a vain hope indeed. That's probably one of the reasons that the scan went so quickly, it was over in about twenty minutes or even less.

The injection of the contrast dye is really weird, it feels really cold as it's going into your arm, which is pretty freaky - add to that the fact that your head is trapped in a cage while they're giving you the inkection and you're worried that the nurse is judging your poor choice of socks, and it's a disconcerting experience.

One of the things that occurred to me in there was - what the hell does the back of an MRI machine look like? I've had three scans and seen plenty of classic hospital drama, but I only know what they look like from the front. For all I know, behind each machine is a large gnome smashing bits of metal together to make the noises.

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*Although admittedly pretty much all my socks have holes in them.

My Last Injection... For Now

On Tuesday morning at 10.15 I had my latest lanreotide injection, and as the initial decision was that I would have them for three months and then review, I'm now waiting to hear back from my endocrinologist as to whether he wants me to continue with the injections. The answer to that will almost certainly be yes, unless the next MRI scan shows that my pituitary tumour has fallen out of my nose at some point in the last two months;* the real question is whether the dosage needs to be increased, and if they're thinking about sending me in for more surgery.

Actually getting the injection was fun, because it was administered by my favourite nurse. I know it's wrong to have favourites, but I was almost heartbroken last month when both she and her lovely Australian colleague were away at injection time and I had to book in with The Rubbish Nurse. She's not a bad nurse, I should clarify, she's very competent, but she hasn't got the hang of Making Injections Fun yet. This is a valuable skill and, in case there are any nurses out there, it goes like this:

The Idiot's Guide To Making Injections Fun:

1. Recognise the patient. If you don't recognise the patient, you can just pretend. This is an acceptable fiction and they will almost certainly pretend back.
Pro tip: Once you are practised at this deception, or if you are interested in a career in acting, consider taking this a step further and invent a complete backstory to your relationship with each patient. Imagining that you are administering an injection to the wife of the man with whom you had a torrid affair in pre-independence Kiribati will add spice to an otherwise dull day.

2. Greet the patient. Do not disappear down the corridor so quickly that they can't work out which dread medical portal you emerged from.
Pro tip: Alternatively, if you really can't bear to wait for your patients to pick up their coats before exiting the waiting room, why not turn this into a game of Hide and Seek (Nurse Edition)? There's nothing like the sight of confused patients blundering into the wrong consulting room to raise a belly laugh in the morning.

3. Put The Patient At Ease. When unwrapping the syringe of lanreotide, remember to refrain from comments such as "Bloody hell, that's a big needle!"
Pro tip: Consider tapping in to your patients' latent competitive natures by introducing a leaderboard of Bravest Patient of the Week. That way, they'll be practically queuing up to be spiked by giant needles, instead of fleeing you in terror.

4. Be Awesome. This guideline may be difficult for new practitioners to grasp immediately. Examples of Being Awesome include (but are not limited to): telling patients interesting medical facts (this week I learned about the sciatic nerve), having an awesome accent, telling amusing family anecdotes, laughing frequently, and adopting unusual pet names for each patient.
Pro tip: Like the finest cuisine, the best pet names are based around animals and vegetables. Everyone's been called "duck" or "pumpkin" - why not mix it up? Try referring to patients as "prarie dog" or "aubergine".

***

In other news, I had a bit of minor drama trying to get hold of my beloved Somatuline Autogel injection this month; when I got the prescription, I headed straight to Boots Pharmacy as usual, who always have to order it in directly from their supplier because it's a pretty unusual item. I happily skipped to the counter, only to be informed that their supplier didn't have any in stock, and they couldn't say when they might have it, so I should go elsewhere.

Somewhat surprised, I decided to transfer my business to the Superdrug pharmacy. "I'll have to check with our supplier," said the young man behind the counter. He immediately phoned them, while standing in front of me. Apparently everything was fine and they'd have it in the next day. Impressed by this speedy service, I skipped off on my merry way.** Of course, next day I got a phone call from them saying that their supplier didn't have any and they couldn't say when it would next be in stock. Heaven only knows who the bloke behind the counter had actually phoned while I was watching; perhaps he's the chap keeping the Speakng Clock in business.

So I picked up my prescription and, feeling a little panicked, decided to try Boots again before walking miles to another pharmacy. And lo! the bloke behind the counter looked at my script and quoth: "Oh yes, we've got that for you." I assumed he was confused - perhaps a relation of the guy in Superdrug. But no! Boots had lovingly ordered in my medication even though they had encouraged me to look elsewhere, just on the offchance I would return for it. So that was nice.

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*Just to clarify for any non-medically-qualified readers: this is unlikely.

**I was doing a lot of skipping that day.

Pituitary Surgery: Question Time with Mr Surgeon

My first piece of advice for patients about to undergo transsphenoidal pituitary surgery: when they invite you to the hospital to "meet your surgeon" before the surgery, don't expect to, you know, actually meet your surgeon. Obviously, that would be mad.

You get to meet a member of the the surgical team. When I was booked in for pituitary surgery, I was told that "my surgeon" would be Mr Hamstercheeks,* a man noted for his skill at rummaging around inside skulls. However, there were at least two other neurosurgeons involved in the operation, presumably for when Hamstercheeks got bored or hungry or felt like helping the anaesthetist with his sudoku.

One of these was Mr. Pout, who I met for my surgical assessment. He was a nice guy, and my main contact with the surgical team; he saw me before the operation, checked up on me every day while I was in hospital, signed me off to go home and then met me again three months later, just to confirm that my head hadn't accidentally fallen off in the intervening period.**

When one of the nurses at the hospital saw that Mr Pout was my surgeon, she almost turned green - with envy, not with sulfhemoglobinaemia. "Ooh," she giggled, "he's very dishy isn't he? He's got beautiful eyes."

Up until that point, it hadn't occurred to me that Mr Pout was good looking.*** As a general rule of thumb, announcing that you intend to drill through their skull is not the best way to generate ardour in a member of the opposite sex. Which may explain why trepanning died out.

Practically an orgy.

In any case, I suddenly realised that, given the number of clean and shiny objects in an operating theatre, an excessively attractive surgeon could be a liability. What if he became distracted by his own reflection? What if the other male surgeons became envious of his hold over the female staff members, deliberately sabotaged my brain and then blamed it on him? What if he discovered his first grey hair, truly realised the transience of beauty in this mortal world, and was left to conduct my surgery through a fog of fatalistic despair?

All in all, I felt much happier about Mr. Hamstercheeks.

Anyway.

My second piece of advice to patients about to undergo pituitary surgery is this: bring a book to your surgical assessment. Better yet, bring two books and a small camping set. Having spent a lot of time at the hospital in recent years, I have become used to lengthy waiting times. I can happily sit for an hour at a stretch examining other patients' facial features and trying to work out who's got acromegaly. I can read trashy magazines and become fully immersed in Jordan's Latest Love Rat Shocker (With Exclusive Pictures Inside!). But I think Neurosurgery holds the record for my longest wait yet. And unlike the Endocrine Unit, the neuro department is miles from a coffee shop.

When I actually got in to see Mr Pout, it was a fairly brief chat. We had a butchers at my MRI and discussed the possible complications of surgery, as follows:

1. death.
2. death
3. DEATH

I'm pretty sure he mentioned some other stuff too, but I have to admit that's what I focused in on. In fairness, the risk of death associated with transsphenoidal pituitary surgery in an otherwise-healthy patient is pretty low, and it's only fair for surgeons to mention in advance that there's a slight risk of death, as with any operation involving general anaesthetic or sharp knives near major blood vessels. If they didn't mention it, I'm sure people would complain when they woke up dead. Plus I guess then if you're merely blinded or lose all pituitary function, you feel like at least it could have been worse. Other possible complications of transspenoidal pituitary surgery include cerebro-spinal fluid leak, meningitis, stroke and coma leading to…you guessed it, death.

My favourite part about meeting with the surgeon was the letter I got afterwards. It was sent from Mr Pout to my endocrinologist, basically confirming that I was a suitable candidate for surgery, and I was copied in on the correspondance.

Here's the bit I liked the best:

"...I note Miss Grey is of petite build and has small nasal passages."

Thanks, Mr. Pout! I never thought of myself as having a "petite build" before. And small nasal passages! You know how to flatter a girl.

In fact, this is neurosurgical shorthand for "book an Ear Nose & Throat team for the surgery, we're not sure her nose is big enough for all the scalpels and cameras and things to fit up there".

I don't know what they write when the ENT people aren't required. Possibly: "I note Miss --- is a bit of a heifer, with a big old conk to match. Tell ENT to take the day off".


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*Personal details may have been subtly altered to protect the individuals concerned.

**A common complication of neurosurgery.

IMFW: Turned Into Bone

This week's IMFW is about an extremely rare and extremely curious genetic illness: fibrodysplasia ossificans progressiva. In this disease, fibrous tissue such as muscle, tendons and ligaments are ossified - literally turned into bone - when damaged.

As you can imagine, the illness causes severe disability, with sufferers becoming slowly trapped inside immovable sheets of bone; new growths of bone often join up with the main skeleton. Bone growths may leave patients unable to eat, speak, sit down or even breathe as the growing bones compress the lungs. Attempts to remove the excess bone usually only results in further growth, because any injury (such as surgery) to fibrous tissue is liable to result in ossification of that tissue. The notable early symptom of this illness is that babies with the genetic mutation which causes fibrodysplasia ossificans progressiva are usually born with deformed big toes; however, the illness is so rare that sufferers are often misdiagnosed, and the bone growths taken to be cancerous tumours.

One notable sufferer was Harry Eastlack, who died before his fortieth birthday and bequeathed his skeleton to medical science. You can see a photograph of it here.

Although the genetic mutation which causes this condition has been identified, there is no cure and no real treatment.

More Famous People With Lumps In Their Head.

So it turns out that by far my most popular post on this blog so far is the one entitled "Russell Watson, It's Not All About You". I don't know whether my readers just happen to have enduring personal grievances with Russell Watson, or are simply opera purists who object to his pop-operatic croonings. Or maybe it's something else.

So, I'm faced with a choice. In my relentless pursuit of pageviews, should I begin writing reams of personal abuse about Mr Watson, or simply continue to shine a spotlight on the other pituitary ademoaners of the world?

I choose the latter option, and not just because of Britain's vast and unyielding libel laws.*

And so, I present:

A Panoply of Pituitary Problems, or: More Famous People With Lumps In Their Head.

Once again I must apologise for the preponderance of people with acromegaly on this list! Acromegaly is an extremely rare illness, caused by a tumor on the pituitary gland which produces excessive growth hormone. However, acromegaly's symptoms are so visually striking that, especially if the illness occurs in childhood - when it will lead to massive growth in height (gigantism), as well as the growth of soft tissue and bone which occur in adult acromegaly - its sufferers are very visible. So-called "giants" are in demand for certain roles in the film and television industry, as well as certain sports where their height gives them an advantage. Consequently, it's relatively easy to find famous acromegaly sufferers, while celebrities who suffer from other kinds of pituitary adenoma may keep their diagnosis private.

I certainly think that it would be helpful if there were celebrities who were known to have Cushing's, or prolactinoma; it helps sufferers to feel that they're not alone, and emphasizes the fact that, while a pituitary adenoma can be a significant bloody nuisance, it's not the end of the world - and that there are plenty of other people going through the same problems.

Obviously I think it would be awesome if a famous person was known to have a TSH-oma/thyrotropinoma. But if that doesn't happen, well I guess I'll just have to step up to the celebrity line!**

Anyway, back to the point. Presenting:

Carel Struycken
Carel Struycken is an actor and an acromegaly sufferer; he stands seven foot tall. Born in the Netherlands in 1948, he's now 63 years old. You might recognise him from playing Lurch in the Addams Family films (click here for a picture!); he's also appeared in Star Trek: the Next Generation, Men In Black, and even Sargeant Pepper's Lonely Heart's Club Band. According to my trusty Wikipedia, he's interested in photography and the development of virtual reality systems. A pretty cool guy by all standards!

Richard Kiel
Richard Kiel is another well-known actor who suffers from acromegaly; his most famous role was as Jaws in the James Bond films. He's now largely retired, although he voiced a character in the animated film Tangled which came out in 2010, and he's written two books; one a memoir entitled Making It Big In The Movies, the second a historical novel co-authored with Pamela Wallace, about the life of Cassius Marcellus Clay, a 19th-Century abolitionist.

Scott Hamilton
Scott Hamilton, the Olympic gold medallist figure skater, is a craniopharyngioma sufferer. I've not previously mentioned craniopharyngiomas, but like pituitary adenomas they're a rare kind of benign pituitary tumour. They cause similar symptoms to pituitary adenomas; they can interfere with hormone production, although they will cause hormone deficits rather than overproduction of pituitary hormones, and they cause headaches and vision loss. They're most common in children and middle-aged adults; Scott Hamilton was diagnosed with craniopharyngioma aged 51. A remarkable guy, Hamilton won four consecutive World Championships and created Stars On Ice.

Hamilton's last performance on Stars On Ice

UPDATE: For those of you who just can't get enough of hearing about famous people with pituitary tumours, I've also written a post about famous people with Cushing's Disease, a post about famous women with acromegaly, my original post about Russell Watson that sparked this whole thing off, and my first post about famous tumourheads!
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*Russell Watson, I love you.

**Admittedly, I haven't quite worked out how I'll achieve fame. Through my own line of edible greetings cards? By streaking at the London Olympics? For my charitable work with walruses? Ideas on a postcard please.

The T-Word

Considering that it's only six letters long, and half of those are cuddly-looking vowels, 'tumour' is a surprisingly big word.* When you put the word 'brain' in front of it, it becomes positively enormous.

I may be biased, but I definitely feel that modern science should devote a little time and energy to investigating the phenomenon of the Brain Tumour Face, which in my experience is virtually universal. The phenomenon is this: when you tell someone that you have a brain tumour, their eyebrows shoot up violently and their mouth goes to a perfect o-shape. They say "oh!", quickly try to get their outlying facial features under control, and then warily ask "is it cancer?" If the answer is "no" (which for me, thankfully, it is) they slowly start to relax again. They may attempt a few further questions which you are ill-equipped to answer and/or they are ill-equipped to understand. This part seems to be optional.

Possibly the Brain Tumour Face is the seventh basic facial expression, common to all peoples and cultures across the earth. It certainly is the reason that it took me so long to mention the tumour to my friends - and even then I chickened out and told most of them over Facebook (I am grateful that no-one clicked 'like'). The problem is that it then becomes a self-fulfilling prophecy; people don't use the word 'tumour' face-to-face, which only serves to increase its fear factor. Even when referred to as a pituitary tumour rather than a brain tumour, the t-word creates quite a reaction; referring to it as a pituitary adenoma merely gets you a blank look, which personally I find preferable.

Even doctors have succumbed to the power of the t-word. Unfortunately, some of the synonyms they end up employing are quite entertaining - my favourite is "lump", which always inexplicably reminds me of the slothful Onslow from Keeping Up Appearances. The first time I went to see my (very lovely) endocrinologist after an MRI found the tumour, he managed to say the t-word only once, right at the end of the appointment, although I did notice a couple of occasions where he started to say it and then quickly caught himself. Or maybe I misinterpreted him and the "tu- er- lump" really is a medical condition.

Personally, I prefer plain speaking. Admittedly, I don't call a spade a spade, but that's purely because I try to keep myself distanced from manual labour at all costs. There's a tumour in my head and frankly I am a lot more concerned about the thing itself than what it's called. It's good that doctors empathise with the fact that their patients are going through a scary time, but continually avoiding all mention of the t-word just makes the elephant in the room swell ever larger. And develop spontaneous tumours.

Naturally there are exceptions to the Brain Tumour Face rule, particularly amongst the medically inclined/drunk. One of my good friends, a medical student, tried to persuade me to go out clubbing one night with the immortal line "Your brain tumour wants you to go!"** Oddly enough, it worked.

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*Of course, if you're an American it's only five letters long, so the vowel quotient is significantly reduced. Does this correspond with a similar reduction in its bigness? Answers on a postcard, please.

** Hi, Havana.

Russell Watson, It's Not All About You

Following my last post about Russell Watson, I felt inspired to find out about some other famous people who have had pituitary adenomas, using the trusty-yet-woefully-incomplete-and-indeed-quite-inaccurate Wikipedia List of Brain Tumour Patients. And I have learned about:

Pío de Jesús Pico

last Governor of California under Mexican rule.

Governor Pico is my absolute favourite discovery. Not just because I love a guy with a sexy beard, not just because of his awesome name, but also because he is a very intriguing case of retrodiagnosis. Pío Pico lived from 1801 to 1894; acromegaly was first identified in 1886 and he was never diagnosed in his lifetime. In 2010, this paper was published suggesting that he suffered from acromegaly. Looking at pictures of him from 1847 to 1858, he progressively exhibits more of the characteristics associated with acromegaly; this picture from 1858 clearly shows a large forehead, big nose and enlarged lips, a hairless face and hairloss from the eyebrows, which could indicate secondary hypothyroidism, and misaligned eyes which could be due to the tumour pressing on cranial nerves. If you look at the article I linked above, there are more photographs which show his huge hands.

But that's not where the interesting ends. The Governor lived well into his nineties - no mean achievement for a Victorian - while the article suggests that around 80% of patients with untreated acromegaly would be expected to die in the first ten years after diagnosis. It seems instead that his pituitary adenoma spontaneously infarcted sometime after 1858; pictures of him as an old man show that his facial features and hands have become much smaller, he has a full beard and his eyebrows have grown back.*

Kevyn Aucoin

American make-up artist and photographer

Another pituitary adenoma and a really sad case. Kevyn Aucoin was a well-known make-up artist and photographer who had worked for Vogue and Revlon, wrote books and appeared on TV. He was diagnosed with acromegaly aged 39, although it's believed he suffered from the condition for some time before it was diagnosed, and the pain of it resulted in an addiction to prescription painkillers. After surgery for his pituitary tumour, his use of painkillers intensified and he died, only a few months later, from liver and kidney failure. You can read about him on his Wikipedia page and this article.

Sun Mingming

7'9" basketball player

You could probably guess from the subtitle that Sun Mingming also has acromegaly (an overrepresented condition in this sample! I guess because the symptoms are so unusual, lazy journalists don't just write "brain tumour" and move on). Pituitary adenomas which secrete growth hormone and develop before puberty result in sufferers becoming very tall; in adulthood it's all about the growth of soft tissues. Sun underwent gamma knife radiosurgery at the age of 23 and is still playing.

James Murphy

Death metal guitarist man

It's been kind of a challenge to discover much about James Murphy and his pituitary macro-adenoma, but in this article he certainly emphasises the fact that it's a benign tumour rather than cancer, and that although it can cause some serious problems and, rarely, death, the prognosis is nowhere near as bad as a cancerous brain tumour. One online forum I bumped across in my researchings was castigating celebrities who fail to make this distinction, so good on him.

From the hints about his ongoing "hormone inhibiting treatment," which on one site is said to be bromocriptine, and the fact that he's not obviously acromegalicious** I'm guessing he has a nasty prolactinoma, but that is just a guess. I'm kind of hoping so, purely because I've found it so hard to get examples of famous pituitary tumourheads who have something other than acromegaly.*** His tumour seems to have been pretty badly located, as they operated basically through his face rather than the nose or mouth, something I hadn't come across before.

***

So there you have it, a brief run down of some famous folk. There are actually quite a few more cases of acromegaly which I came across - people like Andre the Giant, for instance. But that's enough for now.

UPDATE: True to my word, I have written another post about more famous people with pituitary adenomas. I've also written about famous people with Cushing's Disease and the question of whether there are any famous women with acromegaly.
___________________________________________________________
*Sadly, the article notes that he suffered a lot of abuse and discrimination in his lifetime for his unusual appearance.

**Acromegaly sufferers: you should use this word.

***Acromegalicious folk are obviously awesome, but I'm trying to be balanced here. As for finding anyone famous with a TSHoma like me - it's difficult enough just finding published case studies.

So what the hell is actually wrong with you, anyway?

I have long since realised that different people have different levels of interest in what the hell is actually wrong with me anyway, but unfortunately everyone is forced to ask the question in the same way, because Victorian standards of etiquette insist that adding the phrase "Seriously, though, I don't want some really long explanation" after the phrase "So what is your illness?" is rude. Those crazy Victorians! It's political correctness gone mad.

But I am totally fine with that and equally well aware that, whilst phrases such as "cystic degeneration" and "scooping the tumour out through your nose like in Ancient Egypt" undoubtedly have their place, they may result in queasiness among the populace. Especially when sprung on people unexpectedly.

To this end, I have decided to create a variety of possible explanations for what's wrong with me, and you can select the one that appears most suited to your needs.

The Short Explanation:
There's a gland in your head called the pituitary gland. Mine has a tumour on it.

The Long Explanation:
There's a gland just under your brain called the pituitary gland (see above for a quick explanation) which makes a whole bunch of hormones. My pituitary has developed a tumour known as a pituitary adenoma (see the About section for more details). Fortunately the tumour is benign, but it makes a hormone called Thyroid Stimulating Hormone (TSH), which results in me having too much thyroid hormone; that creates all kinds of exciting symptoms like a superfast heartrate and the shakes.*

The Explanation In German:
Die Hypophyse ist eine endokrine Drüse, die unter dem Hirn liegt. Ich habe einen hypophysären Tumor, der Schilddrüsenhormon macht; also habe ich Symptome von Hyperthyreoidismus.

Leider ist mein Deutsch sehr schlecht, also vielleicht ergibt die vorhergehenden Absätze keinen Sinn...

The Explanation In Rhyme:
The pituitary gland
is like a small grain of sand
(except it's the size of a pea).
It sits in your head,
well-behaved (or, instead,
it might swell up exponentially).

My pituitary gland
is a meanie; he's banned
from attending well-thought-of events.
So now he just chooses
to sulk, and he oozes
hormones, with the worst of intents.


I am happy to create further explanations to suit your explanatory needs, although they may not all be entirely explicatory or, indeed, explicable.


* Incidentally, if I've ever been mean/stupid/lazy/exhibited any other undesirable character traits in your presence, it's probably also because of the tumour. I'm actually a really great person.**

** This may or may not be entirely or indeed at all true >.>