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Undetected Benign Tumor Is Dangerous

CancerWise - April 2008

By Darcy De Leon

Paul Coutant

Paul Coutant didn't realize he had any major health problems until a day in April 2005 when he suddenly felt extremely heavy, out of breath and unable to take a few steps.

He was experiencing the symptoms of atrial fibrillation, a cardiac arrhythmia (irregular heartbeat) that increases the risk of stroke. Coutant's cardiologist recognized this as one of the symptoms of acromegaly. The condition develops from a type of pituitary adenoma, or noncancerous tumor of the pituitary gland.

Like many people, Coutant had never heard of the disease and assumed it was a type of cancer.

"When I read adenoma and tumor on my medical report, the only thing I saw was tumor, tumor, tumor," Coutant says. "I went online and looked up the word adenoma and learned that it's not a malignant tumor. I said, 'whew, at least it's not cancer. I think I can handle that.'"

Many patients with a pituitary adenoma live with it for years before they are diagnosed. Symptoms are often slow to develop or mistaken for other conditions.

Rare pituitary disease is diagnosed

That was the case for Coutant, who, for some time, had been experiencing joint pain, which is a common symptom of acromegaly. "I used to think I had arthritis in my knees. I had such trouble walking. I attributed some of it to old age," Coutant, 55, says.

It wasn't until his episode with atrial fibrillation that he realized something more serious was going on. After the incident, he was hospitalized by a cardiologist in Victoria, Texas, where the Houston resident lived at the time.

Tests showed high levels of growth hormone (GH), which is responsible for growth in children and metabolic functioning in adults. An overproduction of GH is the cause of acromegaly. Coutant was then referred to a local endocrinologist, who ordered a magnetic resonance imaging (MRI) scan that found the tumor.

Coutant's endocrinologist referred him to specialists at M. D. Anderson, who treat noncancerous and malignant pituitary tumors.

The pituitary gland and acromegaly

"Even though a pituitary adenoma is not cancerous, it can cause serious health problems and even premature death if not treated properly," says Coutant's endocrinologist Steven Waguespack, M.D., an associate professor in
M. D. Anderson's Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics. Waguespack treats children and adults with pituitary adenomas.

Pituitary tumors develop from a cell in the pituitary gland. Located at the base of the brain, the pituitary gland controls the production of hormones from other glands, such as the thyroid and adrenal glands. Coutant's tumor developed from a pituitary cell that produces GH.

Symptoms vary from patient to patient

Patients who are diagnosed with acromegaly may have one or several symptoms of the disease.

Symptoms of acromegaly can include:

  • Joint pain
  • Cardiovascular disease
  • High blood pressure
  • Acne
  • Lack of a menstrual cycle
  • Thick skin
  • Enlargement of the hands and feet
  • Excessive sweating
  • Snoring and sleep apnea
  • Gradual changes in facial appearance over many years

Acromegaly is a rare disease that is difficult to diagnose because many doctors are not familiar with the condition, and the patients themselves may not recognize the changes that are occurring in their bodies. Some people won't notice a difference in how their body has changed until they compare pictures of themselves from the past with the present, Waguespack says.

Coutant did not have the classic symptoms of acromegaly when he was diagnosed, only the joint pain, atrial fibrillation and high blood pressure.

Surgery, medication improve prognosis

A high school tutor who gives private voice lessons, Coutant scheduled surgery to remove his tumor as soon as the school year ended for summer break.

As a result of the surgery, his joint pain went away. The other conditions are part of the long-term effects of acromegaly. "I don't like the a-fib," Coutant says. "It's hard to sleep at night, and it makes me grumpier than normal – if that's possible. If I didn't have that, though, I would not have known I was ever sick."

Coutant takes medication to control his atrial fibrillation and high blood pressure and also takes medication, as part of a clinical trial, to keep his acromegaly in check. It is one of several clinical trials being conducted at M. D. Anderson studying pituitary adenomas.

Future looks bright

Sometimes pituitary tumors return, but they are slow-growing. Coutant will be monitored with MRIs every few years. At his appointment in March, Waguespack told Coutant that tests showed he was doing well.

Coutant attributes his recovery to the specialized treatment he received for this rare disease.

"I'm so grateful for the medical team I have and the care I've received," Coutant says. "Pituitary tumors are unique, and the nurses and doctors at M. D. Anderson are experts in treating them. If anyone is diagnosed with one, they need to be treated by people who are used to dealing with this rare disease."

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© 2015 The University of Texas MD Anderson Cancer Center