Apathy Syndrome and Pituitary microadenoma??

[Blue727]

I just found this article from The Journal of Neuropsychiatry & Clinical Neurosciences and was wondering if you could comment on the last part of it, which I have asterics in front of;

Although the majority of pituitary adenomas are benign, the physical, emotional, and cognitive changes that these patients experience on their well-being is malignant. Pituitary disease causes a variety of physical illnesses resulting from the alterations in the hypothalamic-pituitary-end organ axis. In addition, patients with pituitary diseases may experience many emotional problems, including depression, anxiety, behavioral disturbances, and personality changes, above and beyond the many reactions these patients may have to the myriad of adjustments that they must make in their lives. There is a growing understanding that pituitary patients may experience these emotional problems as a result of long-term effects that the pituitary tumor itself, treatment, and/or hormonal changes have on the hypothalamic-pituitary-end organ axis.

**********  The authors present a series of cases, in which patients with pituitary disease were diagnosed and treated for depression and showed little response to the treatment for depression. When the diagnosis of apathy syndrome was considered and treatment implemented, the patients’ condition improved. A review of the literature on apathy, hypothalamic-pituitary-end organ axis dysfunction, and treatment for apathy syndrome is included.

I have been on between 35 - 40 anti-depressants and anti-anxiety medications with very, very little help to none whatsoever.  I'm curious about this Apathy Syndrome and how they might treat it differently.  I'm at the point where it is definately worth looking at.  My pituitary microadenoma is only 4mm and located on the right side.  Over the past couple months I have had increasing numbness and tingling on the left side of my head, light headed feelings and sometimes the left side of my head will go completely numb.  I was seen at the Mayo Clinic almost two years ago and they told me they were 100% positive my pituitary microadenoma was not causing me any problems and my symptoms were not related to it at all.  At the time I saw them I was seeing two spots almost constantly out of my right eye, insomnia (which has now become constant fatigue), depression, anxiety, erection problems, shaking, shaking during sex, a feeling of being off balance, uncordinated, severe headaches, severe pain behind and above both my eyes and in the middle of my forehead.  My eyes feel as if though something is trying to push them out.  When I become fatigued my top left eyelid droops, my night vision has become horrific and many other problems.

[rumpled]

*sigh* - I mean, cortisol is needed, and he has to know stress dosing etc - but large regular dosing usually dose more harm than good.

[rumpled]

The cortisol is going to wreck the bones more... I also used GH, like horselip, and my bones improved significantly!

The cortisol will also contribute to fog and confusion... he can simply get steroid induced Cushing's! Replacements are part art, part science and no *body* takes them in the same just as we don't all have the same symptoms or reactions - so you have to know what is going on and adjust. I am very very judicious with my cortisol adjustments and I have no adrenals and need it to live - as too much really throws me into a mess.

He needs help - but cortisol is rarely the answer. He may need thyroid, GH, or other adjustments.

[Viva001]

I was surprised that the endocrinologist said she didn't recommend growth hormone; she told me some % of effectiveness, but it was <10%.
Her recommendations were less desmopressin and/or more cortisol.

I see a lot of brain fog & confusion.  He was always introverted, but now more so.  I think as we age, our personalities can change too.  I used to be more quiet, but sad; now I express my anger--no one likes that!

I look OK too, yet I finally broke down & got a handicapped shield.  Now I see how few spaces there really are.  I have begun writing letters to store managers--no responses.
People have no idea how difficult life is with an invisible illness.

[horselip]

When my pituitary probs began many years ago I was did with osteopenia. Once I went onto rGH this actually reversed and my bones are now good 8 years later. I also try and take the minimal amt of hydrocortisone.

Everyone's is so different. I actually prefer it when I have someone who can come with me to appts. More so that I can really listen to the doc. That second person helps with things that I might be more sensitive about and maybe get a little defensive too. but they also stick up for me and verify things that I say too.

It's hard. If he is sneaking off to appts he must be really sensitive. Tough.
Horselip

[rumpled]

It can effect personality - plus when you are not feeling well, a person is not at one's best anyway.

I hope you can convince him to see the doc with you and that you are being supportive - I know so many spouses that don't really care at all and don't even bother to learn or understand. I think - IMHO - some of this is low growth hormone - it also makes us incredibly isolated.

I know my bones got wrecked up but not to the extent of your hubster - so hang in there and if I can help at all - let me know. I look ok so people cannot accept for the most part that I am disabled - they just don't understand how much of me does not work, and how sick, how fast, I get... like today. Ugh...

[Viva001]

I've been meaning to get back to you.
I spoke with my DH's endocrinologist last week, and she told me that he is not on her recommended dosages!  She said that she didn't think it could affect his personality, but she didn't dismiss it either (unlike the other drs.).  She said that she would love for me to come in with him, as he has been stubborn (lol, am familiar with that).

I'm sorry that you are disabled from this condition; being disabled is tough for so many reasons.  thank you for your input on this forum.