Case 1784 — Hank

Case 1784 — Hank

Episode 1

By 1914, when the drama here played out for real, Harvey Cushing had already done a great deal of work on the pituitary gland and its functions. He was the first to discover it’s capacity as the ‘master gland of the body.’ Also, the fact that it controls growth. One of the more common types of pituitary tumors produces excess growth hormone. This is the cause of illness in our patient.

Imagine how Hank must have suffered. Agonizing headaches and the only pain killers of the period were aspirin and morphine, an opiate derivative of the poppy seed roughly a hundred times less potent than today’s synthetic opioids, such as fentanyl and oxycontin. Indeed, one of the chief drivers of surgery was not to save his life, but to reduce his suffering from headache. In this, his second operation was apparently at least transiently successful.

Progressive blindness is not a part of pituitary tumors today, because they never get big enough to compress the optic nerves, as in Hank’s case. The tumor sits beneath the optic chiasm, the point at which the right and left optic nerves come together at what is very nearly the geographic center of the head. The tumors Harvey Cushing encountered in his patients were huge, and the optic nerves and chiasm were often splayed like tissue paper across the top of them. This is anticipated here by Hank’s blindness, as well as by the pallor of the “optic disc.” The optic disc is what your doctor looks at when they shine that bright and irritating light in your eyes. It is the visible head of the optic nerve and should be robust in appearance. Fun fact: the optic nerve is actually an extension of the brain—the only part of the brain actually visible to the physician on exam.

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