Post by Chris Jackson on Nov 19, 2008 18:32:13 GMT -5
2 worst cases of hypopituitarism I've heard of or dealt with
Written by Chris Jackson Jan 23, 2008
A few of you knew this was coming, well here it is.
The first story, I found over 4 years ago. It stood as the worst hypopit story (when considering closeness to death) I'd heard of until about
2 1/2 years ago.
The second story I dealt with on a personal and private level through emails with the friend of the patient who nearly died because of hypopituitarism about 2 1/2 years ago and a few weeks later, the patient thanked me and sought my advice. I had read in my medical books that hypopituitarism can be fatal in very rare cases, but I figured since I hadn't seen or heard of anyone dieing from it, that it must be extremely rare. After 5 years of helping people, I still haven't seen or heard anyone die from it, but this case came awfully close.
========================================================================================
28-year misdiagnosis placed life on hold
Hormones help make up for lost pituitary
By Nancy Lofholm
Denver Post Staff Writer
Ridgway - "Is your leg feeling good?" the trainer asks the man on the horse.
"Yeah."
"Back feeling good?"
"Yeah."
"OK, then, it's all systems go."
Rick Hanson gingerly lifts the reins and urges the horse into a slow walk.
It's been so long since anything was feeling good. So long since any or all systems have been go.
Rick Hanson, 43, is led on a horse last week by Candida von Braun, director of the Telluride Adaptive Riding Program, alongside volunteers
Clint Viebrock and Barb Zabel.
Hanson, a man his doctors and other caretakers are calling "Rip Van Winkle" for his years lost to illness and now his amazing recovery, spent
the past quarter of a century in a misunderstood void of mental and physical malfunctioning.
Hanson, 43, spent his young adulthood and the passage into middle age broken down like a car running on one of eight cylinders.
His maladies stemmed from the shutdown of a pea-sized gland in the base of the brain that serves as a master switch for the endocrine system
- a network of hormone-producing glands that regulate numerous bodily functions, including growth, the fight-or-flight response to stress,
sexual characteristics, mental acuity and metabolism.
But Hanson had a complicated medical history and so many symptoms that could be blamed on other things. This rare condition, called
panhypopituitarism, was not properly treated.
"It certainly was a failure of the medical system. No doubt about it," said Dr. David Sherwood, the family practice physician in Ridgway who
finally started Hanson on the path to recovery last winter.
Hanson's medical saga began when he was a Hot Springs, Ark., teen who was frail but loved to compete in horseback events. He had suffered mild seizures from the time he was a tot, and as a middle-school student he developed debilitating headaches. In 1974, when he was 13, he was diagnosed with a brain tumor and underwent surgery to remove it. That would be followed by six more surgeries for infections, swelling and biopsies.
Hanson went into a catatonic state following the initial surgeries and had to learn to walk and function again, but he improved enough to return to school and appeared to be headed for a full recovery.
In 1975, his mother, Connie Hanson, packed him up and moved to Colorado to start a new life in the mountains near Ridgway.
But a CAT scan that year would show a new suspicious mass in his brain. Even though a biopsy wouldn't reveal any cancer, his entire head
was treated with radiation.
Years of worsening fate.
For a time he was able to return to a somewhat-normal life, but unknown to his family and those treating him, a door was beginning to shut.
Hanson's pituitary gland was gradually dying.
Without a properly functioning pituitary, Hanson spiraled into illness upon illness. He went through enough medications to stock a pharmacy.
His existence was centered on brain scans, blood tests, neurological assessments and visits to emergency rooms.
His problems were most often attributed to brain damage that physicians believed resulted from all the surgeries. Some prescribed cortisone to ease his symptoms. But he was never given the regimen of hormones that would make up for a dead pituitary.
Hanson was able to walk with some assistance until about six years ago, even though his muscles had wasted away and he suffered muscle
spasticity that was causing his legs to scissor. He was weak and rail-thin. His speech was often slow and slurred.
Occasionally, Hanson would improve - most often when he was given extra cortisone to control swelling in his brain. That cortisone inadvertently eased the real cause of his problems.
And sometimes he would go into near-death crisis, usually when he underwent a surgery or other medical procedure and his cortisone was
stopped.
"Cortisone and prayer kept him alive, but we didn't know why," said Connie Hanson, who said goodbye to her son many times over the years while ministers offered final blessings at his bedside.
Last fall, following a surgery to release the spasticity in his legs, Hanson spiraled into a tortured state.
One of his legs was pulled up to his chin like a stork's. He didn't know what day it was or where he was. He would cry out in pain simply
from being touched.
His mother was prepared to give up on her long battle to care for him at their mountainside trailer. She made plans to put him in a nursing
home for what she believed would be his last days.
"I prayed to God and said, 'You have to do something. Please help us. I can't do this anymore.' I asked him why he kept Rick alive," Connie
Hanson related recently.
She got her answer after she went, as a mother at the end of her rope, to Sherwood for advice. In a serendipitous coincidence, Sherwood recently had attended a seminar put on by an endocrine specialist and researcher who practiced part time in Glenwood Springs. Sherwood referred Hanson to Dr. Joel Ehrenkranz.
Connie Hanson said she'll never forget their first visit to Ehrenkranz. She said she had been used to doctors looking at her damaged son "like he was a rutabaga." Ehrenkranz, she said, walked into the room and stared hard at Rick, who was sitting slumped over and unfocused in his wheelchair. He walked in and out several times, muttering and staring and flipping angrily through Rick's voluminous medical file.
"For someone trained in endocrinology, this kind of jumped out at me. He lacked all hormones. He had been this way for decades,"
Ehrenkranz said months after he had made his diagnosis of panhypopituitarism and confirmed it with blood tests.
Ehrenkranz immediately upped the amount of cortisone Hanson was on and prescribed an additional regimen of daily hormones. Within 48 hours, Hanson was remarkably better. He was holding conversations, even making jokes. He stood up in the hallway at home using handrails.
Ehrenkranz said that having a nonfunctional pituitary gland is a rare condition and can be difficult to diagnose. Many of the symptoms mimic
other problems.
He explained that there was a good reason Hanson worsened when he had surgeries or even teeth-cleaning. The stress would cause his body to go into what is called an adrenal crisis. It couldn't produce the hormones to handle the stress.
Hanson now takes daily hormones that mimic those in a normally functioning body. He downs a thyroid hormone, hydrocortisone and
testosterone, along with medications to lessen seizures and protect against the stomach ulcers that all the other medications could cause. He is able to inject himself with a growth hormone.
Holding reins to recovery
Ehrenkranz said Hanson is about 25 percent into his recovery. The rest won't happen without a lot of effort. His brain and body have been
dysfunctional for too long. He needs extensive physical therapy to walk again. He needs cognitive work for a brain that was left behind in 11th
grade. He must learn ordinary social skills and impulse controls.
Already, Hanson answers the telephone, surprising callers such as Sherwood with his lucid conversation. He has been studying "Gray's
Anatomy" to better understand his condition and reading J.R.R. Tolkien. He has been working on multiplication and state-capital flashcards.
He answers questions on reruns of "Who Wants To Be a Millionaire?"
"His initiation of conversation and his memory is just blowing me away," said home health nurse Elizabeth Miles. "He smiles. He laughs. He
never laughed before."
Candida von Braun, the director of the Telluride Adaptive Riding Program that Hanson participates in, said she is equally impressed with his
progress. Von Braun said that when she first met Hanson last summer, she would have to raise his head to speak to him. This summer, he has
been able to lift a leg over the animal. "It's like witnessing miracles," von Braun said.
The miracles are tempered by the realities of keeping a body on track with hormones that don't occur naturally.
Any minor illness or infection causes a crisis. Even too much mental stimulation can put him in a slump.
Ehrenkranz predicts that with proper treatment, Hanson will be able to live a fairly normal life. Miles said she believes he will be able to walk
again but will always need some care.
For now, Hanson has one prediction about his recovery. When he's back in the saddle, free of his wheelchair and in control of a 1,000-pound animal, he's on top of the world.
He might only be slowly guiding a horse through orange traffic cones in a fenced arena with a trainer and two volunteers walking alongside, but he's doing it with a purpose and goal he hasn't had in 25 years.
"I think," Hanson said with a smile, "I'll be able to ride by myself again."
========================================================================================
This second story is about a woman who lives in Europe. To protect her identity which she guarded and didn't want her name out there, (very private person, posted a few times but not on RTH or STTM that I know of), I will call her by a made up name, Jill. Her best friend who even if I could remember her name (I'll call her Sue), I also couldn't say here, contacted me in email that Jill was on her death bed (do not recusitate order or DNR) in a hospital ICU because she "accidently" took too much morphine from the pump. Jill was shown how to do this to cause a fatal dose if the pain got too much for her. Jill's nurse did not know about the DNR and so she revived her. Jill was in a coma and doctors gave her days to live at best.
The docs had earlier identified that Jill had adrenal insufficiency, but because of absorption issues which had caused a stroke, Jill had to be put
on solucortef IV instead of Cortef. Sue brought me into the picture 2 days after Jill's morphine overdose and acted as a go between for Jill's husband and me.
I poured over all Jill's labs which included several hormone tests. I was also given some medical history which included severe hemorrhage
during child birth. Some of you might have a red light go off as I did.
Could Jill have Sheehan's syndrome, a form of hypopituitarism caused by severe blood loss. I scrutinized her labs and found she had low pituitary hormones including dirt low ACTH. She also had dirt low cortisol as well as secondary hypo. I don't remember what the numbers were or what the other pit hormones were, I was to worried and focused on her almost non-existent cortisol level. I told the friend Sue to tell the doctors to try Jill on solu-medrol as I suspected solu-cortef would not be strong enough for her and that I thought she had Sheehan's Syndrome.
Sue emailed me the next day to tell me that Jill woke up about 2 hours after she was put on solu-medrol and was doing real good. There seemed to be no damage from the morphine. Later, Sue told me the doctors diagnosed Jill with secondary AI and Sheehan's only because I suggested it.
The doctors also treated her secondary hypothyroid condition later on. Her improvement was quick and one of the more remarkable I've seen. She is no longer in pain from I assume was fibro, but I didn't ask at the time. I assume she's still doing ok since I haven't heard anything for over 2 years.
I didn't write this to impress you all. There are many people who can recognize that Jill likely had Sheehan's and needed Solu-medrol. I'm glad I was there to help. I wrote this and posted the first story primarily to remind you all that there is always someone worse off, but also for educational and interest value.
Written by Chris Jackson Jan 23, 2008
A few of you knew this was coming, well here it is.
The first story, I found over 4 years ago. It stood as the worst hypopit story (when considering closeness to death) I'd heard of until about
2 1/2 years ago.
The second story I dealt with on a personal and private level through emails with the friend of the patient who nearly died because of hypopituitarism about 2 1/2 years ago and a few weeks later, the patient thanked me and sought my advice. I had read in my medical books that hypopituitarism can be fatal in very rare cases, but I figured since I hadn't seen or heard of anyone dieing from it, that it must be extremely rare. After 5 years of helping people, I still haven't seen or heard anyone die from it, but this case came awfully close.
========================================================================================
28-year misdiagnosis placed life on hold
Hormones help make up for lost pituitary
By Nancy Lofholm
Denver Post Staff Writer
Ridgway - "Is your leg feeling good?" the trainer asks the man on the horse.
"Yeah."
"Back feeling good?"
"Yeah."
"OK, then, it's all systems go."
Rick Hanson gingerly lifts the reins and urges the horse into a slow walk.
It's been so long since anything was feeling good. So long since any or all systems have been go.
Rick Hanson, 43, is led on a horse last week by Candida von Braun, director of the Telluride Adaptive Riding Program, alongside volunteers
Clint Viebrock and Barb Zabel.
Hanson, a man his doctors and other caretakers are calling "Rip Van Winkle" for his years lost to illness and now his amazing recovery, spent
the past quarter of a century in a misunderstood void of mental and physical malfunctioning.
Hanson, 43, spent his young adulthood and the passage into middle age broken down like a car running on one of eight cylinders.
His maladies stemmed from the shutdown of a pea-sized gland in the base of the brain that serves as a master switch for the endocrine system
- a network of hormone-producing glands that regulate numerous bodily functions, including growth, the fight-or-flight response to stress,
sexual characteristics, mental acuity and metabolism.
But Hanson had a complicated medical history and so many symptoms that could be blamed on other things. This rare condition, called
panhypopituitarism, was not properly treated.
"It certainly was a failure of the medical system. No doubt about it," said Dr. David Sherwood, the family practice physician in Ridgway who
finally started Hanson on the path to recovery last winter.
Hanson's medical saga began when he was a Hot Springs, Ark., teen who was frail but loved to compete in horseback events. He had suffered mild seizures from the time he was a tot, and as a middle-school student he developed debilitating headaches. In 1974, when he was 13, he was diagnosed with a brain tumor and underwent surgery to remove it. That would be followed by six more surgeries for infections, swelling and biopsies.
Hanson went into a catatonic state following the initial surgeries and had to learn to walk and function again, but he improved enough to return to school and appeared to be headed for a full recovery.
In 1975, his mother, Connie Hanson, packed him up and moved to Colorado to start a new life in the mountains near Ridgway.
But a CAT scan that year would show a new suspicious mass in his brain. Even though a biopsy wouldn't reveal any cancer, his entire head
was treated with radiation.
Years of worsening fate.
For a time he was able to return to a somewhat-normal life, but unknown to his family and those treating him, a door was beginning to shut.
Hanson's pituitary gland was gradually dying.
Without a properly functioning pituitary, Hanson spiraled into illness upon illness. He went through enough medications to stock a pharmacy.
His existence was centered on brain scans, blood tests, neurological assessments and visits to emergency rooms.
His problems were most often attributed to brain damage that physicians believed resulted from all the surgeries. Some prescribed cortisone to ease his symptoms. But he was never given the regimen of hormones that would make up for a dead pituitary.
Hanson was able to walk with some assistance until about six years ago, even though his muscles had wasted away and he suffered muscle
spasticity that was causing his legs to scissor. He was weak and rail-thin. His speech was often slow and slurred.
Occasionally, Hanson would improve - most often when he was given extra cortisone to control swelling in his brain. That cortisone inadvertently eased the real cause of his problems.
And sometimes he would go into near-death crisis, usually when he underwent a surgery or other medical procedure and his cortisone was
stopped.
"Cortisone and prayer kept him alive, but we didn't know why," said Connie Hanson, who said goodbye to her son many times over the years while ministers offered final blessings at his bedside.
Last fall, following a surgery to release the spasticity in his legs, Hanson spiraled into a tortured state.
One of his legs was pulled up to his chin like a stork's. He didn't know what day it was or where he was. He would cry out in pain simply
from being touched.
His mother was prepared to give up on her long battle to care for him at their mountainside trailer. She made plans to put him in a nursing
home for what she believed would be his last days.
"I prayed to God and said, 'You have to do something. Please help us. I can't do this anymore.' I asked him why he kept Rick alive," Connie
Hanson related recently.
She got her answer after she went, as a mother at the end of her rope, to Sherwood for advice. In a serendipitous coincidence, Sherwood recently had attended a seminar put on by an endocrine specialist and researcher who practiced part time in Glenwood Springs. Sherwood referred Hanson to Dr. Joel Ehrenkranz.
Connie Hanson said she'll never forget their first visit to Ehrenkranz. She said she had been used to doctors looking at her damaged son "like he was a rutabaga." Ehrenkranz, she said, walked into the room and stared hard at Rick, who was sitting slumped over and unfocused in his wheelchair. He walked in and out several times, muttering and staring and flipping angrily through Rick's voluminous medical file.
"For someone trained in endocrinology, this kind of jumped out at me. He lacked all hormones. He had been this way for decades,"
Ehrenkranz said months after he had made his diagnosis of panhypopituitarism and confirmed it with blood tests.
Ehrenkranz immediately upped the amount of cortisone Hanson was on and prescribed an additional regimen of daily hormones. Within 48 hours, Hanson was remarkably better. He was holding conversations, even making jokes. He stood up in the hallway at home using handrails.
Ehrenkranz said that having a nonfunctional pituitary gland is a rare condition and can be difficult to diagnose. Many of the symptoms mimic
other problems.
He explained that there was a good reason Hanson worsened when he had surgeries or even teeth-cleaning. The stress would cause his body to go into what is called an adrenal crisis. It couldn't produce the hormones to handle the stress.
Hanson now takes daily hormones that mimic those in a normally functioning body. He downs a thyroid hormone, hydrocortisone and
testosterone, along with medications to lessen seizures and protect against the stomach ulcers that all the other medications could cause. He is able to inject himself with a growth hormone.
Holding reins to recovery
Ehrenkranz said Hanson is about 25 percent into his recovery. The rest won't happen without a lot of effort. His brain and body have been
dysfunctional for too long. He needs extensive physical therapy to walk again. He needs cognitive work for a brain that was left behind in 11th
grade. He must learn ordinary social skills and impulse controls.
Already, Hanson answers the telephone, surprising callers such as Sherwood with his lucid conversation. He has been studying "Gray's
Anatomy" to better understand his condition and reading J.R.R. Tolkien. He has been working on multiplication and state-capital flashcards.
He answers questions on reruns of "Who Wants To Be a Millionaire?"
"His initiation of conversation and his memory is just blowing me away," said home health nurse Elizabeth Miles. "He smiles. He laughs. He
never laughed before."
Candida von Braun, the director of the Telluride Adaptive Riding Program that Hanson participates in, said she is equally impressed with his
progress. Von Braun said that when she first met Hanson last summer, she would have to raise his head to speak to him. This summer, he has
been able to lift a leg over the animal. "It's like witnessing miracles," von Braun said.
The miracles are tempered by the realities of keeping a body on track with hormones that don't occur naturally.
Any minor illness or infection causes a crisis. Even too much mental stimulation can put him in a slump.
Ehrenkranz predicts that with proper treatment, Hanson will be able to live a fairly normal life. Miles said she believes he will be able to walk
again but will always need some care.
For now, Hanson has one prediction about his recovery. When he's back in the saddle, free of his wheelchair and in control of a 1,000-pound animal, he's on top of the world.
He might only be slowly guiding a horse through orange traffic cones in a fenced arena with a trainer and two volunteers walking alongside, but he's doing it with a purpose and goal he hasn't had in 25 years.
"I think," Hanson said with a smile, "I'll be able to ride by myself again."
========================================================================================
This second story is about a woman who lives in Europe. To protect her identity which she guarded and didn't want her name out there, (very private person, posted a few times but not on RTH or STTM that I know of), I will call her by a made up name, Jill. Her best friend who even if I could remember her name (I'll call her Sue), I also couldn't say here, contacted me in email that Jill was on her death bed (do not recusitate order or DNR) in a hospital ICU because she "accidently" took too much morphine from the pump. Jill was shown how to do this to cause a fatal dose if the pain got too much for her. Jill's nurse did not know about the DNR and so she revived her. Jill was in a coma and doctors gave her days to live at best.
The docs had earlier identified that Jill had adrenal insufficiency, but because of absorption issues which had caused a stroke, Jill had to be put
on solucortef IV instead of Cortef. Sue brought me into the picture 2 days after Jill's morphine overdose and acted as a go between for Jill's husband and me.
I poured over all Jill's labs which included several hormone tests. I was also given some medical history which included severe hemorrhage
during child birth. Some of you might have a red light go off as I did.
Could Jill have Sheehan's syndrome, a form of hypopituitarism caused by severe blood loss. I scrutinized her labs and found she had low pituitary hormones including dirt low ACTH. She also had dirt low cortisol as well as secondary hypo. I don't remember what the numbers were or what the other pit hormones were, I was to worried and focused on her almost non-existent cortisol level. I told the friend Sue to tell the doctors to try Jill on solu-medrol as I suspected solu-cortef would not be strong enough for her and that I thought she had Sheehan's Syndrome.
Sue emailed me the next day to tell me that Jill woke up about 2 hours after she was put on solu-medrol and was doing real good. There seemed to be no damage from the morphine. Later, Sue told me the doctors diagnosed Jill with secondary AI and Sheehan's only because I suggested it.
The doctors also treated her secondary hypothyroid condition later on. Her improvement was quick and one of the more remarkable I've seen. She is no longer in pain from I assume was fibro, but I didn't ask at the time. I assume she's still doing ok since I haven't heard anything for over 2 years.
I didn't write this to impress you all. There are many people who can recognize that Jill likely had Sheehan's and needed Solu-medrol. I'm glad I was there to help. I wrote this and posted the first story primarily to remind you all that there is always someone worse off, but also for educational and interest value.