The gland that makes Goliath of David

My wedding ring doesnt fit anymore doctor said David 47 a prosperous banker Before he completed his story his chatty wife downplayed the symptoms I think its his excuse to want to appear single again I smiledEvery few months he says his shoes dont fit He gets jazzier pairs and also says he cant see clearly So he goes and buys a new set of glasses His jaw is now prominent and he walks around like John Travolta He speaks in this hoarse voice trying to sound hot and all she concluded placing her palms on the table to give me her final diagnosisJust when I thought she was done she added Please ask him to lose weightLet me know if you remember anything else youre missing I said turning my attention to the patientMy head hurts and I get tired soon David said And my vision is a bit blurry Ive suddenly grown all over and look like a giant in the mirrorI held his hands as he outstretched them to gesticulate what he was describingThe wife pulled out a picture of their wedding day from 15 years ago He looked like another man The difference was like between David and Goliath but they were the same personYouve got acromegaly I said going straight to the point after an examination The hormonal disorder develops when the pituitary gland produces excessive amounts of the growth hormone during adulthood The bones and soft tissues increase in size leading to the symptoms David describedThe pituitary or hormoneproducing gland is the size of a pea and receives messages from the hypothalamus to stimulate all other hormoneproducing glands It for instance controls the thyroid and tells the kidneys how much water to conserve by producing the vasopressin hormoneI asked for an MRI of the brain an eye checkup and a battery of blood tests to see if any other hormone was affected As he rose David asked calmly What do I do about the headacheStay away from her for a while I wanted to say as I scribbled a prescription They returned with the reports in a few days handinhand As expected the scan revealed a 3cm tumour in the pituitary gland pressing on his optic nerves causing the diminution in vision This tumour is producing the excess growth hormone I pointed out on the MRI and we have to remove it with an operation because it is also pressing on your optic nerves The good bit was that we didnt need to open his head like neurosurgeons wouldve done a few decades ago We could remove it using a specialised endoscope from the nose Multiple questions later they agreed to the surgeryMedical experts believe that Goliath the Philistine giant mentioned in the biblical Book of Samuel also had pituitary adenoma leading to his sizeThe endoscope when manoeuvred through the small structures of the nose that clean and humidify air allows you to reach the base of the skull where in a small depression of the bone resides the pituitary gland smack between the carotid arteries the main arteries supplying blood to the entire brain Through the nostrils we got a panoramic view as we took multiple pieces of the tumour and removed them completely making sure we preserved the normal gland which looked a little firmer and more pinkishEach time I perform this operation I think of Dr Ari Chacko my mentor who trained me in this surgery His exuberant enthusiasm on seeing the normal pituitary gland after removing the tumor flashes before my eyes I secretly wish that I can operate like him one dayWe reconstructed the base of the skull and within a few hours after surgery David confirmed that his vision appeared brighterThree months later he had lost the weight and his wife was delighted that the ring fit again His growth hormone levels came back to normal I told him he was cured but had to continue following up with me for the rest of his life My headache is gone he said I looked at the wife wondering if she had anything to say Im happy hes my David again not GoliathThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals You can reach him at mazdaturelgmailcomCatch up on all the latest Mumbai news crime news current affairs and also a complete guide on Mumbai from food to things to do and events across the city here Also download the new midday Android and iOS apps to get latest updates