No one believes that the fat man "like a deflated ball" in front of him is the sven thin young man on the ID card. What makes a 36-year-old boy "unrecognizable"? The original problem is the brain! After careful multidisciplinary treatment by Huashan Hospital affiliated to Fudan University, Xiaoshi has fully recovered.
Fatal obesity proved to be Cushing's syndrome
Since 20 16, Xiaoshi has obviously "gained weight": I thought people were "stressed out" when they were over 30, but dieting and exercise were useless anyway, and at the same time, their blood pressure was out of control. At the beginning of this year, ordinary antihypertensive drugs could not control his blood pressure at all, and there were many discomforts: blurred vision, groggy, feeling hungry every day, barely enough to drink at least five liters of water. Xiaoshi made up her mind to go to the local hospital for treatment.
The result was surprising: the doctor suspected that his symptoms were caused by Cushing's syndrome. This rare disease is due to the excessive secretion of glucocorticoid in the body, which leads to electrolyte disorder and protein, sugar and fat metabolism disorder, resulting in a series of "unrecognizable" symptoms.
It is reported that Cushing's syndrome, also known as "hypercortisolism", is characterized by obesity, hypertension and diabetes. In the early days, it was easy to be misdiagnosed. Once untreated, it will affect many organ systems in the whole body within a few years, causing serious harm: full moon face, buffalo back, centripetal obesity; Diabetes; Hypertension, atherosclerosis, heart failure; Purple skin, muscular atrophy, osteoporosis and fracture; Decreased immunity leads to various infections; Female amenorrhea, infertility, male hypofunction, infertility; Emotional instability, psychopathy, alternating depression and mania, insomnia, memory loss ... It can be said that there is nothing normal in the whole body, and the mortality rate is four times that of the normal population. Hearing this result, 36-year-old Xiaoshi and his family were shocked at the time.
The culprit is hidden in the pituitary gland, as small as soybeans.
On the recommendation of a local doctor, Xiaoshi came to Shanghai to see a doctor at the "Golden Pituitary" multidisciplinary clinic of Huashan Hospital affiliated to Fudan University, which is a famous pituitary tumor clinic.
Professor Ye, deputy director of endocrinology department, explained: Cushing's syndrome is a clinical incurable disease with complicated causes. Strict endocrine evaluation and imaging examination are needed to make clear the cause before targeted treatment can be carried out. She further elaborated that if the lesion is in the adrenal gland, it can be basically cured by surgical resection; If the lesion does not come from adrenal gland, further functional examination and imaging examination are needed to determine whether the lesion comes from pituitary gland.
Step by step, the diagnosis was ruled out, and finally, through the "gold standard" bilateral inferior petrosal sinus venous blood sampling (BIPSS) examination, it was confirmed that the "cortisol increase" of Xiaoshi was indeed caused by the pituitary gland located in the deep brain, and the focus was located on the left side of the pituitary gland.
The pituitary gland, as small as a soybean and weighing only 3 grams, is located in the saddle area in the deep center of the brain and is the "headquarters" in charge of the neuroendocrine system. Once the tumor secreting adrenocorticotropic hormone (ACTH) grows, it will continuously stimulate adrenal cortex proliferation and secrete too much cortisol. Invited domestic big-name experts from neurosurgery, endocrinology, radiology and other disciplines to participate in the discussion. Experts finally reached an agreement: Xiaoshi's condition is pituitary ACTH tumor, which is Cushing's disease, and endoscopic surgery is the first choice.
"Patients usually have only one operation."
In mid-July this year, Xiao Shi successfully moved into the multidisciplinary fusion ward of Huashan Golden Pituitary in Hongqiao Campus. Headed by Academician Zhou Liangfu, director of neurosurgery in Huashan Hospital, the ward is mainly composed of pituitary sub-specialists in neurosurgery and endocrinology. It is the first multidisciplinary comprehensive ward for pituitary diseases in the real sense in the world, with the most authoritative experts and the most advanced instruments and equipment in the field of pituitary disease treatment.
Professor Zhao Yao, vice president of Hongqiao Campus of Huashan Hospital and head of Huashan Golden Pituitary Tumor Diagnosis and Treatment Center, said that compared with other types of pituitary tumors (such as prolactinoma and acromegaly), Cushing's disease is "the most intractable": small in size, concealed and intractable. Tumors are often only a few millimeters, and sometimes they can't be found on magnetic resonance images. The pituitary gland should be explored repeatedly during the operation. It also likes to grow close to the aortic wall, "accidentally breaking blood vessels", causing fatal bleeding.
The most difficult problem in dealing with this pituitary tumor is that once the tumor is not completely removed in the first operation, even if it is only a little, the patient's symptoms will soon recur. Because there will be a lot of scar tissue in the operation area, it is difficult to find the small tumor left over from the first operation. "Patients usually have only one operation." Professor Zhao said.
On July 17, Professor Zhao Yao performed "minimally invasive resection of pituitary adenoma through nasal cavity assisted by nasal endoscope" for Xiaoshi. During the operation, the doctor used advanced endoscopic equipment to enter from the center of the nose, opened the saddle floor and saw a small gray tumor on the left side of the pituitary gland near the blood vessel wall, which was carefully removed. The surgical team repeatedly explored all parts of the pituitary gland to make sure that there was no tumor residue before ending the operation. Postoperative measurement showed that the tumor was only about 0.5 cm in diameter.
The miracle of "reborn" happened!
On the first day after the operation, Xiaoshi said, "It's so uncomfortable, like people are going to faint!" " The doctor was very happy to hear that the patient was in a state of cortisol surge for a long time before operation; After the tumor was cut clean, the blood cortisol level fell to the "bottom" and the body was extremely uncomfortable. This is a sign of progress, just like "death and afterlife"
Follow-up treatment by professional endocrinology team in fusion ward. In just a few days, Xiaoshi's body has miraculously undergone a series of changes: a fat face like a full moon has become smaller and thinner day by day; The whole body skin gradually becomes smooth and white from the original rough reddish brown; On the second day after operation, blood pressure returned to normal and hyperglycemia disappeared. No longer "overeating", I lost weight 12 kg in just seven days after operation, and I felt very relaxed all over!
Professor Zhao Yao said that the treatment effect of Cushing's disease was immediate, the tumor was cleaned up, the endocrine-related indicators were immediately relieved, and the symptoms disappeared quickly; On the contrary, it means that the cutting is not clean. Therefore, the release of endocrine indicators is "the only criterion for testing truth". At present, the international surgical remission rate of Cushing's disease is about 70% to 85%, and the surgical endocrine remission rate of Cushing's disease patients admitted to the pituitary tumor fusion ward of Huashan Hospital in 20 19 > is 90%. "
A few days ago, Xiaoshi, who was reborn, once again walked into the multidisciplinary fusion ward of Huashan Golden Pituitary for a follow-up visit. "ah! It turns out that you are really as handsome as in the photo! " Seeing that Xiaoshi's posture and appearance have returned to normal, the medical staff in the ward can't help joking and are really happy for him.