Do You Have a Prolactinoma? Then Read On!
Initially diagnosed with a prolactinoma (pituitary adenoma), I was advised to beware of possible vision difficulties. The reason is that as the tumor grows (seemingly harmlessly as it is not cancerous), it could get large enough to put pressure on surrounding brain tissues. If it grows up, it hits the optic nerve. Mine grew to the right. One day I was suddenly seeing double! By the end of three days, it was extreme. I was given a quick appointment for a thorough eye exam (it took three hours) by a high-powered UVA ophthalmologist, as well as a second MRI (magnetic resonance imaging). The next day I was scheduled to meet with my endocrinologist and my neurosurgeon.
“You’ve got sixth nerve palsy. Your abducens nerve has been damaged by the tumor.”
What Does All This Mean in Simple Language?
The pituitary gland is right below the brain’s bottom center. It secretes hormones and interacts with a variety of glands that regulate many of the bodies critical processes. Occasionally, things go awry and a tumor grows, perhaps slowly. I was told a prolactinoma is never a cancerous condition. All my doctors assured me of it, as did a number of online sources. However, a prolactinoma, also called a pituitary adenoma (microadenoma if small, macroadenoma if large) is a nuisance tumor as mentioned earlier. It put pressure on my abducens nerve, causing it to palsy (loss of ability to move a body part). I was thus prescribed a steroid medication, dexamethasone, to shrink the swollen tissues and reduce pressure on the nerve.
The double vision is easy to explain. The muscles of the eye are controlled by nerves. The sixth nerve, or abducens nerve, controls my right eye, but due to the tumor’s pressing on it, it is not working properly. My right eye does not coordinate with my left one, and I see double. This alerted the physicians to respond quickly, because sixth nerve palsy is frequently reversible, especially if treated early. Other nerve palsies are not always so responsive. Damage to those nerves can be irreversible. So I am fortunate.
Surgery and Complications
Surgery is tentatively scheduled for ten days in the future, as that is the earliest available time for a non-emergency. While being given a workup, I was asked many health questions, having to do with the heart and lungs and other major organ systems. I was basically clear – or so I thought – until my wife mentioned my CPAP breathing device. This seemed a modest difficulty to me, however the nurse though it quite serious. She still does not know the adjustments that will need to be made because of this. I am not allowed to use my CPAP for two weeks after surgery, since the surgery takes place through an opening in the vicinity of the CPAPs functioning. Will there be oxygen? Will there be special monitoring? Will I be propped up to breathe at night? Finally, will I regain total use of my eye?
Those questions have not yet been answered.
1. Personal Experience, My UVA Endocrinologist, My UVA Neurosurgeon.
2. eMedicine Abducens Nerve Palsy Article.