Angie Yawn, 49, is used to solving problems. She’s been setting up and fixing computers in the Henry County school district in Georgia for more than two decades. But when she started experiencing a mix of seemingly unrelated symptoms that lasted more than six years and stumped eight different doctors, she thought she had run out of options.
“I had bruising that would last more than eight months. My heart would race all the time, and even when I was laying down, it felt like I was running a marathon. I couldn’t sleep, and I was gaining lots of weight,” Yawn says. “I had really high blood pressure, and my face would turn beet red for no reason. I was also very forgetful and losing lots of hair. No one could figure out what was wrong. I was completely and utterly defeated and started to wonder if I was crazy and that it was all in my head.”
Turns out, Yawn had a pituitary tumor.
The pituitary gland is a very small organ—about the size of a pea—that sits at the base of the brain.
“If you imagine your head is like a ball, the pituitary gland sits right in the center of that ball,” says UNC Health neurosurgeon Nelson M. Oyesiku, MD. “It’s equidistant from both your ears, your nose and the back of your head.”
Called the master gland, the pituitary gland controls the function of the endocrine system, which produces all of the body’s hormones. This includes common hormones you may have heard of—estrogen, testosterone, growth hormone and cortisol—and not-so-common ones, such as prolactin, which causes the breasts to grow and produce milk during pregnancy and after birth.
“The pituitary gland makes hormones function consistently, regularly and in harmony,” Dr. Oyesiku says. “It’s a conductor of all the endocrine organs.”
A Pituitary Tumor Causes Chaos in the Body
A pituitary tumor is an abnormal growth that is usually benign (not cancerous), but it can cause the pituitary gland to make either too many or too few hormones.
“When it makes too much, things go out of kilter. Your body’s metabolism and hormonal functions go out of whack as a result of an excess of a hormone that’s produced way out of proportion to the needs of the body,” Dr. Oyesiku says. “Usually it’s one or sometimes two hormones at a time that are out of alignment.”
Conversely, the tumor may prevent the gland from producing enough of a hormone.
“You have too little thyroid, too little prolactin or too little estrogen and so on, and that can throw metabolism out of whack as well,” Dr. Oyesiku says.
Yawn’s tumor caused Cushing’s disease, which makes too much adrenocorticotropic hormone (ACTH)—the hormone that produces cortisol, commonly referred to as the stress hormone.
“Cortisol is crucial for life, but if you make too much, it’s a problem. The ACTH that was being produced in the pituitary gland was telling her adrenal gland to make lots of cortisol. So she was making six times as much cortisol as she might need, and that causes a variety of problems,” Dr. Oyesiku says.
Cushing’s Disease Can Be Hard to Diagnose
Unfortunately, too much cortisol can cause other conditions, which makes diagnosing Cushing’s disease very difficult.
For example, too much cortisol can lead to diabetes because it elevates blood sugar.
“If you don’t treat it, you can go into a diabetic coma. So if you had symptoms of diabetes and went to your doctor, they might treat you for diabetes, but the underlying cause is actually Cushing’s disease because it mimics diabetes,” Dr. Oyesiku says.
Cortisol can also drive your blood pressure up, so you might be treated for hypertension.
“You certainly have hypertension, but it’s from the problem with the Cushing’s tumor, not conditions that typically cause high blood pressure,” Dr. Oyesiku says.
Too much cortisol can make you gain weight, but the problem is not obesity—it’s weight gain caused by Cushing’s disease.
“If you don’t treat the root cause, you may help one or two symptoms, but at the end of the day, the patient is still struggling to find a resolution,” Dr. Oyesiku says.
This is what happened to Yawn. In the six years after her symptoms started, she went to several different doctors, who spent years treating her for high blood pressure and telling her to exercise more and eat less, even though she was nearly starving herself to try to lose weight.
“My calorie intake was below 600 a day, and yet I was still gaining 2 pounds a day,” Yawn says. “My doctor told me I needed to exercise more.”
Finally, Yawn found her way to an endocrinologist who recognized the signs of Cushing’s. Further tests confirmed the diagnosis.
Traveling Seven Hours for Surgery
Pituitary tumors are not common—about 10,000 are diagnosed each year in the United States. They are also located in an area of the brain that affects many vital functions.
“The gland sits at a vital crossroads in the brain. It’s surrounded by major blood vessels on four sides,” Dr. Oyesiku says. “None of those vessels are expendable. Injury to any of those vessels could be calamitous.”
That’s why it’s important to be treated by someone with expertise in removing pituitary tumors. For Yawn, that meant traveling seven hours from her hometown of Griffin, Georgia, to UNC Hospitals in Chapel Hill to be treated by Dr. Oyesiku, who is acknowledged worldwide as one of the most skilled and experienced pituitary surgeons.
“I was a nervous wreck because I knew I had a tumor, and in my mind he was the only shot I ever had for a normal life,” Yawn says. “But the minute I met him, he was so calming and knowledgeable. I knew I was in good hands.”
On Sept. 6, 2021, Dr. Oyesiku and UNC Health otolaryngologist Brent A. Senior, MD, performed the four-hour surgery to remove Yawn’s tumor.
She returned to work less than a month later.
“Once you remove the tumor, the results can be pretty quick,” Dr. Oyesiku says. “Their physical condition reverts. Diabetes goes away, high blood pressure goes away, bone density improves, and they’re thinking clearly. From the surgeon’s standpoint, there’s nothing more gratifying than to treat a patient with Cushing’s, put them in remission and change the trajectory of their future health and life. It’s a transformative event.”
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