Has Obama Had Brain Surgery?

I ran across this (slightly old) news story while searching for pictures of MRI scanners, and it was a revelation to me! Being across the pond in Merrye Olde Englande, I had heard that the rabid frontiers of the American right wing are convinced that Barack Obama is a Muslim who was born outside of the US, but I hadn't come across the parallel accusation that he's had brain surgery, based on what supposedly looks like a scar on the back of his head. There was coverage in the Daily Mail - and David Icke, everyone's favourite herpetologist, also jumped on the theory: a sure sign of credibility.

Obviously the pictures mean pretty much nothing at all. Maybe his hair just grows that way. Maybe he cut his head open in the playground as a kid. Maybe he actually did have brain surgery. Maybe those scars are where his lizard masters buried into his body and started wearing him like a glove. But the rhetoric around it all was both amusing - why is it that apparently becoming the President of the United States entitles the world and his dog to see your complete medical records? - and sad.

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.

What Should I Blog About?

This is a question I frequently ask myself. Recently it occurred to me to use the Google AdWords Keywords search - which shows you the number of searches for particular keywords globally - to see how many searches are made every month for the different topics I write about on this blog. As you hopefully have noticed, I blog chiefly about my experiences with my rare tumour of the pituitary gland, which secretes too much thyroid stimulating hormone (TSH). This kind of pituitary adenoma is sometimes referred to as a thyrotropinoma, or a TSH-oma. But they're very rare, so I wondered - how many people are even looking for information about this online?

It's not looking good:

Thyrotropinoma: 28 searches per month.
TSH-oma: 480 searches per month.
TSH secreting pituitary adenoma: 170 searches per month.
Grand Total: 678 searches per month across the entire world.

So although no-one could deny that this blog has certainly found a niche in the market, it looks like my target audience is pretty minute. Hearteningly, searches for "pituitary adenoma" are much higher, so that may help. Plus, Blogger gives you a breakdown of the search terms that people used to find your blog, so you can see what searches are the most popular. It's an eclectic bunch; my favourites from the past week include "extreme fat men", "barber with no legs" and "can you get nigeri fowleri from picking your nose".

So in future I'm afraid those are the topics I'll be focusing on.

Anyway, this evening I'm off to the hospital for my latest MRI scan! Note that I use "latest" both in the sense of "most recent" and "overdue", as I was supposed to originally have it in February and they failed to book me in. Again. Nevermind! There's nothing I enjoy more than going for an MRI at 7pm at night. I didn't even know hospitals had outpatient appointments for scans that late in the evening!

Anyway, I shall be reporting back tomorrow...

IMFW: Out Of Gas

Only a brief Interesting Medical Fact of the Week this time - and indeed it's only tenuously medical. Did you know that MRI scanners use helium to run? So does the Large Hadron Collider. Liquid helium is used to cool the super-conducting magnets sitting inside these machines and working hard at being magnetic.

Now I'm the first to acknowledge that's not a particularly interesting fact. But it leads on to the actual interesting fact, which is that the world is running out of helium; the US Government decided to sell off its federal helium reserve in the 1990s, which lead to extremely low helium prices. And that could have concerning consequences for medical imaging in the future. This would not be good; MRI scans are great because they don't use ionizing radiation, and they give good images of soft tissues compared with CT scans.

And as a bonus fact; MRI scanning rooms are usually equipped with oxygen monitors in case of unintentional shutdown, in which the liquid helium inside the scanner would boil. If it's not able to escape through a vent, the helium gas could escape into the scanning room and suffocate everyone. Whoop whoop!

Double-Edged Sword

I've written a fair bit about acromegaly in the past - caused by a pituitary tumour secreting high levels of growth hormone, it can lead to gigantism if it occurs in childhood. But you may not have heard of pituitary dwarfism, which is effectively the opposite of acromegaly - although there's usually no tumour involved - in which the pituitary gland fails to secrete enough growth hormone. If a child with pituitary dwarfism is left untreated, this can lead to permanently stunted growth.

Recently the world's tallest man, Sultan Kosen, has been in the news; his growth, caused by a pituitary adenoma, has finally been brought under control after surgery and medical treatment. Even so, he stands over 8 feet tall. In contrast, Special Olympics athlete Mackenzie MacDonald who has also been in the news was successfully treated for her childhood pituitary dwarfism, attaining a height of 5'4".

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.

IMFW: Nodding Disease

For today's Interesting Medical Fact of the Week, we're going to get a little bit Agatha Christie. I love Agatha Christie, because a) I love mysteries and b) I'm an old granny at heart. But in terms of mysterious illnesses, this one takes the biscuit.

So-called nodding disease (or nodding syndrome) was first described in the mountains of Tanzania in the 1960s. Since then, it's spread to areas in south Sudan and northern Uganda. It's an extremely serious progressive disease which only affects children, and it's almost always fatal. There is no cure. And no-one is even sure what causes the illness.

The symptoms of nodding disease include complete and permanent stunting of growth, including development in the brain, which leads to mental retardation. The name of the illness comes from the characteristic seizures suffered by affected individuals, which cause their heads to nod rapidly; the only treatment currently available for nodding syndrome is epilepsy drugs which can help to control these seizures. Extra weird is the fact that these seizures seem to happen most commonly when the child begins eating or feels cold. Children become severely malnourished because they are frequently rendered unable to eat. Many children with nodding disease actually die from falls or accidents like drowning or burning, which they're at higher risk of because of their mental impairment.

At the moment, the hypothesis that seems most likely to explain this disease suggests that it may be linked to river blindness (onchocerciasis), an illness caused by a kind of parasitic worm which is transmitted to humans through the bite of the black fly. Cases of nodding disease are concentrated in areas where there are high levels of infection with the river blindness parasite and it seems there may be a link, although no-one's yet worked out what it is. There may also be a link with low serum concentration of the blood.

There is a little bit of good news. The mysterious illness has attracted some international attention, and this week Uganda opened its first treatment centres specifically for children with nodding disease. At the moment, though, the best they can aim for is to control the illness's symptoms.

Travel to Mars, deform your pituitary gland...

Todays papers have been awash with the news that astronauts may suffer side effects from spending long periods of time in space; specifically, their eyesight may be damaged due to effects which appear similar to intracranial hypertension; i.e. increased pressure in the head. Their eyeballs have literally changed shape, making them more longsighted - which, in the case of those astronauts who started off with short sight, has actually improved their vision.

In pituitary-relevant news (which this blog is always excited about), doctors examined 27 astronauts who each had a cumulative total of at least 30 days in space, and of those 27, three were found to have slightly deformed pituitary glands. I have struggled to find any more details on exactly how their pituitaries were "slightly deformed"; I presume that their pituitary glands may have become somewhat flattened along the interior walls of the sella turcica cavity. And although that sounds suspiciously precise coming from me, I promise I'm not making shit up; that's what happens in primary empty sella syndrome, which can be a sign of intracranial hypertension.

Shit, where'd I leave my glasses?

IMFW: Don't Be So Prosthetic

After last week's Interesting Medical Fact of the week focused on glass eyes, I decided to stick with a winning theme and move on to a post about prostheses of all shapes and sizes.

BBC News have this jolly picture book of prosthetic limbs throughout the ages, which is well worth a look; my favourite is probably the Ancient Egyptian prosthetic toe; found on a mummy and dating back to at least 750 BC, it's the oldest functioning prosthetic ever discovered. Earlier prosthesis exist which appear to have been crafted to replace missing body parts after death - so that the person could enter the afterlife whole. But the bottom of this wooden toe shows wear and tear, indicating that it was used during the Egyptian woman's lifetime. Big toes support about 40% of the weight on each foot, meaning that losing one can upset your balance and slow you down. Plus, although it's quite possible to walk and move around without a toe, a prosthesis can protect the foot where the amputation occured and may be more aesthetically pleasing. Apparently Egyptologists have been seeking volunteers who've had their big toe amputated to try on replicas of the ancient prosthesis to see if it's effective at aiding balance and walking.

And this wooden toe was so well crafted that it's still attached to its owner's foot, 2750 years later.


Warning: prosthetic toe may not be detachable



Pituitary Surgery: Pre-operative Assessment

After meeting my pituitary surgeon Mr Pout, I was trundled off to have my pre-operative assessment. The NHS wesbite describes pre-operative assessments as:

"...carried out prior to treatment, [to ensure] that the patient is fully informed about the procedure and the post operative recovery, is in optimum health and has made arrangements for admission, discharge and post operative care at home. "

I met a very nice nurse and her very nice (and extremely lengthy) questionnaire, which we got to fill in together. What a treat! I got to answer questions about my health, fitness, medications, allergies, medical history and more. It was like being on Mastermind, except the nurse was a lot more judgemental than John Humphrys when I couldn't remember an answer.* Possibly it was more like University Challenge, in the rounds where you're not supposed to confer.


Wait... who actually is my GP?

After hearing about the more technical (and terrifying) side of transsphenoidal pituitary surgery from Mr Pout, the pre-operative assessment was a chance to find out more about the practical side of things, like visiting hours for my ward in the hospital, what would happen in the lead-up to my surgery, and exactly how nice my parents had to be to me for how many weeks afterwards.

With the benefit of hindsight, I would have taken my cue from John Humphrys and done some slightly more thorough interrogation of both the nurse and surgeon. The problem is, you don't know what you're not being told until some time after they've not told you it.

I would have appreciated being told, for example, that after my surgery, I had to have blood tests done every hour for six hours, then every two hours for twelve hours, then every four hours, etc etc. Admittedly, I have complained about this in a previous post. But the thing was, although I understand that the blood tests were necessary to keep track of my pituitary hormones, it wasn't until after they'd already done a couple of rounds of blood tests that I was even told exactly how long it was going to go on for. And my arm was really sore because they kept putting surgical tape on it (it appears there's no plasters on the NHS) and then ripping it off every five minutes to stick another needle in. If only I had shaved my inner elbows.

Plus, it would have been helpful to know precisely what scan they were intending to send me in for on the day of the surgery. This got super confused on the day, and I'll talk more about it in a future post, but I was never told that they wanted me to have a CT scan of my pituitary before surgery, so I was completely confused when a couple of hospital porteers turned up to wheel me away to the scanning department.

Also at the pre-operative assessment, you get weighed and measured and have your blood pressure taken. If it's a little low like mine usually is, and if they suddenly realise that (thanks to their insane waiting times) you haven't eaten anything since before you turned up to the hospital six hours ago, they may give you free cake and biscuits. These are of a surprisingly high quality for hospital-supplied nibbles.

Oh, and they swab you to check whether or not you have MRSA bacteria present on your skin. If you do, you might be put last in the day's queue for surgery.

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*Incidentally, did you know that the format of Mastermind was allegedly inspired by creator Bill Wright's experience of being interrogated by Nazis?

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.

Pituitary Tumour Surgery: Hypophysectomy or Adenectomy?

I can't believe that it's March already! This time last year, I was in a flurry of nervousness, waiting to find out the date of my pituitary surgery. Before setting a definite date, you get the chance to meet your surgeon and you're called in for a pre-operative assessment.

At the time, I was informed that the full name for standard pituitary surgery is transsphenoidal hypophysectomy. On reflection, this seems strange because "hypophys-ectomy" implies that they're aiming to cut out ("-ectomy") the whole pituitary gland ("hypophys-") when, in fact, the aim is to cut out the pituitary tumour while leaving the healthy gland intact. I've also seen the phrase "transsphenoidal adenectomy" used for the same procedure, but in fact that's even less specific as the "aden-" part just means "gland", so an adenectomy is simply the surgical removal of any gland. An adenoma-ectomy would indicate surgery to cut out a glandular tumour, and a quick scan of Google indicates that this phrase is also in use amongst the medical profession. How confusing.

Excuse the unexciting etymological rambling, but this has literally only just occurred to me.

ANYWAY.

A word of advice to anyone about to undergo pituitary surgery: don't tell your friends and family that you're going to a pre-op assessment for a transsphenoidal hypophysectomy. They will either gaze at you blankly and without comprehension, or they will hone in on the words "pre-op" (as in TRANSSEXUAL) and "blah-blah-physectomy" (sounds a bit like VASECTOMY) and ask if you're secretly a man.*

This may be upsetting.

In any case, I think that the pre-operative assessment and Question Time with Mr Surgeon probably deserve posts to themselves, so on that bombshell... adieu.

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* Or presumably, if you are male, whether you're about to become a woman.

IMFW: Eyeing It Up

BBC News had this story about Jost Haas, the last maker of glass eyes in the UK. Did you know that the earliest known evidence of use of an ocular prosthesis* comes from the body of a woman from Iran, dating back to 2900-2800 BCE, buried with a prosthesis made of bitumen paste, covered in gold. Glass eyes only began to be produced by the Venetians in the late sixteenth century; nowadays, they are more commonly made from synthetic materials and may have all sorts of exciting features - even devices which imitate the reaction of a normal pupil to light.

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*A glass eye, except dating from the pre-glass era.

A New Treatment for Cushing's Disease?

I've just been reading about a drug called Pasireotide. It's been around for a while, but on January 23rd this year, the European Medicines Agency's Committee for Medicinal Products for Human Use recommended that pasireotide be approved for use in the treatment of Cushing's Disease. This is exciting, because Cushing's Disease - in which a benign tumour of the pituitary gland causes the body to release excess steroid hormone - has long been very difficult to treat medically, with surgery and radiotherapy being the main treatments. But they're not always appropriate or successful for every patient.

Pasireotide (brand name Signifor, developed by Novartis) is a somatostatin analogue - like the medication lanreotide, which I take at the moment to prevent my own pituitary tumour from releasing thyroid-stimulating hormone. Like lanreotide and octreotide, the two somatostatin medications currently on the market, pasireotide looks likely to be effective in treating acromegaly and neuroendocrine tumours; unlike them, it appears to be much more effective at blocking tumours from producing adrenocorticotrophic hormone.

At the moment, there are no approved medicines in Europe for the treatment of Cushing's. Other drugs are used in practise, off-label, but with less data about their safety and effectiveness against the disease, so for Signifor to be approved would be a very significant step. The European Commission looks set to make its decision in the next few months.