Natalia Cherry's Acromegaly Story
Finding the Right Diagnosis
I was 31-years-old when I noticed I started developing a fat pad in between my shoulder blades, and weird hair growth on my abdomen. In general, I just was not feeling good. I scheduled an appointment with my primary care doctor and he did a small work up, which included blood work and a couple of 24-hour urine collections, but everything came back normal. At that time we figured I was just getting fat in a weird spot, and moved on.
Fast forward 10 years, I woke up one morning and the vision in my right eye was blurry and I was very dizzy. This carried on for a few days, and got worse. I became so dizzy that I was unable to walk straight, the vision in my right eye was still blurry, and I did not feel right, so I went to Urgent Care. While in Urgent Care I could not pass any of the neurological checks, so I was sent to the emergency room to rule out a stroke. Once in the ER I had a CT scan which came back negative for a stroke, but showed an abnormality in my pituitary fossa, the structure that houses the pituitary gland. I was advised to have an MRI through my primary doctor, which I did, and it showed a macroadenoma – a benign tumor - on the right side of my pituitary gland.
My primary care physician sent a referral out to Stanford on a Monday, and by that Thursday I had a scheduled first appointment on the books. My first appointment at Stanford was with Dr. Laurence Katznelson in Endocrinology. He walked into the room, introduced himself, looked at me and said, "I think I know what's wrong with you, and I think we can fix it. But first I want to ask you some questions". He asked me a handful of questions regarding how I have felt over the course of the last few years, and also about changes I have seen happen to my body. Every single question he asked, I had indeed experienced over the last 10 years; from significant weight gain to bone changes in my feet and face, and chronic fatigue. Dr. Katznelson concluded that I likely had acromegaly, a hormonal disorder that usually affects middle-age adults. He then asked if I would have some labs drawn while we waited for the neurosurgeon he works with to finish up in the OR. I had labs drawn and then met with the neurosurgeon, Dr. Juan C. Fernandez-Miranda, who explained to me that he would be able to remove the tumor, and what to expect before, during, and after the procedure. I was then introduced to Dr. Fernandez-Miranda's nurse practitioner who went over a quick assessment, asked me some questions, and got me a surgery date. I left that day with a very overwhelming sense of calmness. What could have been a very scary experience, was instead fantastic and reassuring. As labs started flowing into my MyHealth app, I also received a call from Dr. Katznelson who diagnosed me with Acromegaly, and explained what his role would be in my recovery post-surgery, what I would most likely experience in the hospital, and what to expect from an endocrine standpoint in the future.
Brain Surgery at Stanford
Two weeks later I returned to Stanford for my pre-op appointments, and to have surgery the following day. On the day of surgery check in went well, and pre-op preparation was great. I met multiple physicians from the ENT group, the Neurosurgery group, and the Endocrine group, and all were very pleasant and informative. There was a slight delay in my surgery start time, but the staff kept me informed as to why, and Dr. Fernandez-Miranda came and checked in with me while I waited.
Dr. Fernandez-Miranda and Dr. Zara Patel took me into surgery that evening and performed a transsphenoidal adenomectomy – removing the pituitary tumor through my nose; a very delicate surgery but one that meant I didn’t have to have my skull opened. I later learned that my surgery was quite challenging; the tumor turned out to be larger then the original imaging showed, they found abnormal connections between an artery and the veins in the back of my eye which complicated the removal of the tumor, and it required extra work to excise.
I stayed in the hospital a little under 48 hours post-surgery. I was visited both days by all three groups to check up on how I was doing. What was supposed to be a 3 day post-op stay ended up not even being 48 hours because I was not having any of the possible complications we originally thought I might have had due to the Acromegaly. Discharge went smooth, and I had a member from each team go over my discharge instructions pertaining to their specialty before I left. Once home, recovery was amazing! I felt great and I had no major complications. I did struggle with low blood sugars for a week or so, but I called and spoke to the Endocrine team, and was advised on what to do to deal with them. I had a post-op appointment follow up with Dr. Fernandez-Miranda and also with Dr. Patel, which went well. My instructions from Dr. Patel were clear and easy to follow, and I have had no issues with my nose since being home.
Life After Surgery:
My latest lab result showed a "Normal" reading of my IGF1 (growth factor), which is a major testament to the true skill of my surgeon because it means he was able to remove the entire tumor. It is thanks to Dr. Fernandez-Miranda's ability as a neurosurgeon that I will not need radiation, monthly medication injections, or a second surgery, and no more of all the symptoms that made me feel horrible - from a patient’s standpoint that is HUGE!
I feel amazing, and I am getting my life back! I really had no idea just how bad I had gotten over the years, and how horrible I was feeling, until now. Now I have so much energy, I don't know what to do with myself! I knew I was always feeling so exhausted, but I didn't realize just how exhausted I was until I started feeling normal again. I now look in the mirror and I see my face, not the puffy, bright red mess that it was. I can’t remember the last time I saw my eyes this bright and white, without swollen eye lids! My friends and family all say that I made brain surgery look easy. But it wasn't me, it was the skill and expertise from my physician team that made brain surgery easy! Being the Director of Nursing at a local hospital where I live, I can tell you that the care I received from start to finish was amazing. The teams that I dealt with while at Stanford were nothing short of perfection, from the office staff to the hospital staff, I could not have asked for better. Dr. Fernandez-Miranda, Dr. Katznelson, and Dr. Patel and their teams will always hold a special place in my heart because of the care they gave, and the concern they showed, while I was there. Every aspect of this journey at Stanford was made easy and effortless by the staff there, and I would recommend it to anyone.
Written by: Natalia Cherry
Innovations in the Surgical Treatment of Acromegaly at Stanford
Selective Resection of the Medial Wall of the Cavernous Sinus
Pituitary adenomas often invade the medial wall of the cavernous sinus, but this structure is generally not surgically removed because of the risk of vascular and cranial nerve injury. This results on incomplete tumor resections and persistent disease in functional tumors.
Dr. Fernandez-Miranda has meticulously investigated the medial wall of the cavernous sinus introducing a classification of the parasellar ligaments and their role in anchoring the medial wall, and has developed an innovative technique for selective resection of the medial wall when invaded by tumor.