A Diligent Effort
Giving a human face to Cushing's disease
Iencountered Harvey Cushing as neither a doctor nor a medical educator but as the eponym of a disease. My battle with the condition that bears his name probably began five to eight years before I knew I had it—or at least that's how long my doctors hypothesize that the 1.1-centimeter tumor in my pituitary gland had been growing.
In 2004, my primary-care doctor in Massachusetts noticed that I had suspiciously high blood pressure, which did not drop even after I changed my diet and began taking antihypertensive medication. I had a magnetic resonance angiogram and blood tests, but the results were inconclusive. So I began to dig on my own—in journals and online—into what might be causingmy symptoms. I finally concluded that Cushing's disease was a plausible explanation. I had heard of it in animals, because I had recently interned in a veterinary research lab, where I was working on the optimization of a cortisol test for diagnostic purposes. I could not believe how accurately all of the disease's common symptoms mirrored changes I'd been noticing in my body and my general well-being.
I had previously attributed these changes to my lifestyle or to genetics, never suspecting that they could be indicative of a serious medical condition. I'd noticed that I was gaining weight in my face and belly, for example, but blamed it on poor eating and partying my senior year in college. I might not have appeared particularly overweight, but for someone who is 5'5" and normally weighs 110 pounds to gain an oddly distributed 25
pounds within a matter of months was troublesome. More troublesome still was the fact that I didn't lose any weight even
after I began a summer job that had me eating well and working out daily. The excess dark hair on my arms and face I thought must be due to my Italian heritage. The anxiety, irritability, and spontaneous emotional rollercoaster rides must, I told myself, be because I'm an overachiever who constantly worries about making the grade.
But even I was unable to come up with an explanation for my loss of scalp hair, suddenly diminished capacity for physical activity, easy bruising, and frequent colds and strep throats.
In September of 2004, when I began graduate studies in molecular and cellular biology at DMS, I set out to find an endocrinologist. Dr. Lee Witters, a professor ofmedicine and of biochemistry (and the author of this issue's feature about Harvey Cushing), put me in touch with Dr. John Turco, an endocrinologist and the director of the Dartmouth College Health Service. Wasting no time, Dr. Turco confirmed that I had a pituitary tumor, and I was officially diagnosed as having Cushing's disease.
That November, I had two transsphenoidal surgeries—a technique pioneered by Cushing. Dr. Benoit Gosselin, a Dartmouth otolaryngologist, skillfully navigated my nasal passages, and Dr. Nathan Simmons, a neurosurgeon, removed my tumor. Or so we thought. But my cortisol levels did not normalize, so I had the same operation a week later in hopes of removing any residual hypersecretory cells. (Coincidentally, I'd witnessed this procedure at a medical forum five years before, though to remove another type of
Pattin is in her fourth year of graduate studies in molecular and cellular biology at Dartmouth Medical School.