Dr.DheerajBojwani Consultants

Website : www.dheerajbojwani.com

Dr. Dheeraj Bojwani Your Medical Tour Consultant in India

Pituitary Tumour Surgery and Treatment in India

Overview:

The endocrine system is made up of glands that secrete chemicals called hormones into

the bloodstream. The Pituitary gland, a pea-sized structure is the master gland. It is

located at the base of the brain just behind the nose. The pituitary controls the other

glands of the endocrine system and keeps hormone levels in check. The pituitary gland is

controlled by substances (releasing or inhibitory factors) that are sent by the

hypothalamus. The pituitary gland, in turn, secretes hormones into the bloodstream. Most

of these hormones are chemical messengers that instruct various glands to secrete their

own hormones.

Functions of Pituitary Gland:

The pituitary gland controls several important bodily processes .Some of the key hormones includes:

� Adrenocorticotropic hormone (ACTH) - stimulates the adrenal glands to produce the hormone cortisol, essential to regulate blood pressure and blood sugar levels.

� Antidiuretic hormone (ADH) - also called vasopressin, regulates water balance.

� Follicle stimulating hormone (FSH)- and luteinising hormone (LH) - regulate the menstrual cycle in women, sperm production in men and sex hormone levels in both sexes.

� Growth hormone - influences an individual’s height, contributes to bone and muscle building and restricts accumulation of body fat.

� Oxytocin - involved in childbirth and breastfeeding. This hormone is also thought to play a role in counteracting the physical effects of stress.

� Prolactin - stimulates milk production from the breasts after childbirth to enable nursing. It also affects sex hormone levels from ovaries in women and from testes in men.

� Thyroid stimulating hormone (TSH) - stimulates the thyroid gland, which regulates the body's metabolism, energy, growth, and nervous system activity.

Pituitary Tumour:

A pituitary tumour is a mass of cells that grow on the gland. Some secrete hormones. The majority of pituitary tumors (adenomas) do not spread outside the skull (nonmetastatic) and usually remain confined to the pituitary gland or nearby brain tissues. Generally, pituitary tumours are benign and slow growing, and pituitary cancers are extremely rare. Benign tumours don’t spread to other parts of the body, so there is no chance of secondary tumours developing. The pituitary gland is divided into two main parts: The anterior pituitary and the posterior pituitary. Two-thirds of all pituitary tumors occur in the anterior or front portion of the gland.

Symptoms of Non Functioning Tumours:

� Loss of peripheral vision is often the first sign � Decreased energy � Hair loss � Low blood pressure � Weight gain � Impotence � Menstrual irregularity

Functioning Tumors/Secretory Tumours: Functioning tumors are those that produce excessive amounts of specific hormones, each with its own set of symptoms. Functioning/ Secretory pituitary tumors are named after the hormone they secrete: Prolactin (PRL) Tumours - PRL tumors are the most common pituitary tumour. PRL stimulates lactation in women. PRL tumours cause excess PRL production.

Symptoms PRL Tumours:

� In men excess PRL leads to impotence, infertility, erectile dysfunction. � Irregular menstrual cycles or cessation of menses (amenorrhea) � Inappropriate production of milk (galactorrhea), � Loss of body hair � Decreased sex drive � Growth Hormone (GH) Tumours – approximately 20 percent of all pituitary tumors are GH secreting tumors. It

stimulates the liver to produce another hormone, Somatomedin - C or Insulin-Like Growth Factor-1 (IGF-1). This hormone, in turn, regulates the growth of bones, muscles and many other organs. These tumors produce excess growth hormone.

Symptoms of GH Tumours:

� In children, excess production leads to gigantism � In adults, it leads to enlargement of the hands, feet and jaw (acromegaly). � Diabetes mellitus, � Hypertension � Some develop colon polyps and cancer.

Types of Pituitary Tumours:

Pituitary tumors can be divided into two broad categories:

Non-functioning Tumors/Non-Secretory Tumors: The hormonally quiet tumor

grows to oversized proportions, actually growing to the point of lifting up and

stretching the optic nerves (especially where the nerves from both eyes cross

as they travel to the brain) and other cranial nerves. These tumors can grow to

be quite large as they do not signal their presence with an excess of

hormones. They are usually found only when symptoms of compression are

noted.Non-functioning tumors may also interfere with the pituitary gland's

normal production of hormones.

� Coarsened facial features

� Misaligned teeth (malocclusion)

� Degenerative arthritis

� Excess sweating

Adrenocorticotropic Hormone (ACTH or Cushing's disease -ACTH stimulates the adrenal gland, to secrete cortisol a

glucocorticosteroid). Among other things, Cortisol helps the body deal with stress and disease. ACTH tumors represent 15

percent of pituitary tumors. They are more common in women than men. Cushing's syndrome can be a result of many things,

including excessive intake of commonly prescribed medications containing steroids.

Symptoms of Adrenocorticotropic Hormone (ACTH):

� Hypertension and excessive hair growth (Hirsutism)

� Exaggerated facial roundness moon face

� A characteristic hump on the upper part of your back, excessive fat buildup in various areas, neck (buffalo hump) and

abdomen

� Muscle weakness

� Stretch marks

� Thinning of your skin, Bruising

� Depression

� Centripetal obesity

� Osteoporosis (thinning of the bones)

Thyroid Stimulating Hormone (TSH) Tumour - TSH stimulates the thryroid gland to secrete thyroid hormone, which regulates

metabolism. TSH tumours are rare.

Symptoms of Thyroid Stimulating Hormone (TSH) Tumour:

Excess production leads to hyperthyroidism

� Sudden weight loss

� Rapid or irregular heartbeat

� Nervousness or irritability

Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) - In women, FS and LH help regulate egg production by the

ovaries and control the menstrual cycle. In men, these hormones help regulate the testes' production of sperm and

testosterone. Excess production can lead to abnormalities with these functions. These tumors are also rare.

Diagnosis: Pituitary tumors can be difficult to diagnose, particularly in the early stages. Non-functioning tumors may not cause

any symptoms until they grow larger, and symptoms of functioning tumors are similar to those of many other medical

conditions. In fact, many pituitary tumors go undiagnosed for many years. There are several types of tests used to diagnose

pituitary tumors. The doctor will decide which tests to conduct based on the patient's symptoms

Preliminary Diagnosis:

� Family history of pituitary gland tumors, hyperparathyroidism (overactive parathyroid gland), multiple kidney stones,

multiple stomach ulcers, hypoglycemia (low blood sugar) or pancreatic gland tumors is examined.

� A physical examination identifies signs of pituitary tumors and other health problems.

� A neurological examination includes visual field testing, hearing, balance, coordination and reflexes.

Depending on the results, the physician may request one or more of the following tests:

Biochemical Testing - Blood and Urine Test are used to measure hormone and to detect excess production or deficiency. Often, further hormone stimulation or suppression testing is needed.

Magnetic Resonance Imaging (MRI) Scan - MRI, the standard imaging test for pituitary tumors, uses magnetic fields and radio waves to generate images. MRI can easily identify large tumors (macroadenomas) of the pituitary gland and is also good at identifying most small tumors (microadenomas). But MRI may not detect many microadenomas smaller than 3 millimeters (about one-eighth of an inch).

Petrosal Sinus Sampling - Adrenocorticotropic (ACTH) hormone-secreting pituitary tumors are often too small for detection by MRI scans. When patients have blood or urine tests indicating excess ACTH production, but MRI results are normal, petrosal sinus sampling testing may be recommended. This test determines if an ACTH-secreting pituitary tumor is present and also can help define its location.

Biopsy - A biopsy (taking a sample of a tumor and examining it under a microscope) may occasionally be recommended by your doctor for definitive verification. Pituitary tumors can be examined under a microscope before or after surgery to determine the tumor type.

Treatments for Pituitary Tumours:

60-70 percent of small, nonfunctioning pituitary tumors are carefully observed over time and do not require treatment. Treatment is considered if the tumor grows and causes symptoms. If there is no growth, observation is continued.Treating pituitary tumors may involve surgery to remove the tumor, drug therapy to reduce excessive levels of hormones produced by the tumors, radiation therapy to shrink tumors or a combination of these therapies. Treatments for each patient are determined by the tumor's location, size and the specific hormones being overproduced. Treatment options include:

Medical Treatment of Pituitary Tumours :

Treatment with medications may help in blocking excess hormone secretion and can sometimes shrink certain types of pituitary tumors.

� Prolactin hormone-producing tumors are often treated with Dopamine agonists (eg cabergoline, bromocriptine); Octreotide or long-acting versions which decrease secretion of prolactin hormone and generally reduce tumor size.

� They are usually so effective that surgery is not required. � Growth hormone - producing tumors can be treated with two classes of medications. These medications are typically

recommended when surgery has been unsuccessful in treating excess hormone production � Somatostatin analog drugs decrease growth hormone production and may decrease tumor size. � Pegvisomant blocks the effects of excess growth hormone production on the body. � Surgical Treatment of Pituitary Tumours :- Surgery is often done to remove the tumor and is generally considered to be

the primary treatment for pituitary tumours. The effectiveness of surgery depends on tumor type, location, size, and whether it has spread into nearby tissues. The rest of the normal pituitary gland may be damaged during surgery.This can be treated by replacing the missing hormones with pills or other forms of hormone replacement.

� Transphenoidal Endoscopic Tumor Removal Pituitary tumor is removed through the nasal cavity using a microscope and endoscope-assisted technique that results in no visible incision. Traditionally, this approach was done through an external incision under the lip. In this surgery no other part of the brain is touched and there are hardly any neurological complications without leaving any visible scar This technique also requires a shorter operating time and hospital stay than the traditional method. Most patients stay in the hospital overnight and experience a dull headache for several hours up to several days after surgery. If the tumor is small, the cure rates after surgery is about 70-80%. If the tumor is large or has affected the nearby eye nerves or brain tissue, removing the entire tumor becomes more difficult. But,in most cases, the majority of the tumor can be removed successfully.

� Radiation Therapy Radiation therapy involves the use uses high-energy rays to destroy tumors to destroy tumor cells. Radiation therapy is often recommended when pituitary tumors persist or return after surgery and cause symptoms not relieved by medications. It also may be used if surgery is not possible.

The types of radiation therapy used to treat pituitary tumours include

Conventional Therapy/ External - beam Radiation - In External-beam radiation therapy, radiation is directed at the pituitary from a source outside the body. Although effective, this therapy has some drawbacks. It can take years before the tumor growth and/or hormone production is fully regulated. There could be some damage to surrounding nerves and normal pituitary functions can also be affected.

Stereotactic Radiosurgery - Stereotactic radiosurgery is the most commonly recommended treatment when surgery has not been successful. This technology allows an intense and high dose of radiation beam is targeted directly at the tumor to deliver the tumor with minimal exposure to surrounding healthy tissue. Unfortunately, this therapy cannot be used for tumors in close proximity to important nerves, such as those needed for vision.

Proton Beam Radiotherapy - A beam of protons (positively charged particles) is directly focused on the tumor.

Fractionated Stereotactic Radiotherapy - This technique delivers carefully targeted radiation to areas of tumor growth over the course of multiple therapy sessions that deliver smaller units of radiation. The number of treatments depends on tumor size and location.

Gamma Knife Radiosurgery - Gamma knife radiosurgery has the advantage of delivering a high dose of radiation in a single fraction while minimizing the risk of damage to the nearby visual nerves and normal pituitary gland. Also, Gamma Knife offers the convenience of a single treatment compared to several weeks of fractionated radiation therapy. Overall, Gamma Knife radiosurgery has a very high chance of preventing further tumor growth -- and in some cases shrinking the residual tumor -- with very little risk of visual loss or damage to the hypothalamus. While Gamma Knife radiosurgery can be utilized as either the primary or secondary treatment for pituitary tumors, it is generally reserved as second-line therapy after residual or recurrent tumor is noted.

Treatment Options for Complicated CasesTranscranial Tumor Removal - Usually, it is the procedure is for large and complicated tumors. It also is recommended when the pituitary tumor is in a location that cannot be accessed using the transphenoidal endoscopic technique.

Chemotherapy - Chemotherapy can reduce over-production of hormones from pituitary tumors, or block the effects of these hormones. This treatment is an option when the tumor has spread beyond the pituitary gland.

Benefits of Treatment for Pituitary Tumours:

� Treatment can be given for different types of pituitary tumour and the potential benefits will vary for each person. Doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical symptoms of pituitary Tumours. Many treatments used today are less intensive and more effective than treatments used in the past which makes recovery after surgery quicker.

� Treatment of pituitary tumours is usually very successful, although many people will have to continue taking hormone replacements, sometimes for the rest of their lives. Regular check-ups at an endocrinology clinic are likely and may continue for several years. Patients may have further scans performed and will have blood tests to monitor your hormone levels.

� Better methods of surgery to remove pituitary gland tumors are being investigated. Even large tumors and tumors that have invaded nearby structures are now able to be removed with surgery.

� People recovering from a pituitary gland tumor are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended certain tests. Moderate physical activity can help you rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level.

Medical and health care services in India are attracting over a million patients every year and have made India a popular destination for different types of medical treatment, surgical procedure, and complementary therapies. Extremely high standard of quality care is maintained in all the major hospitals and other medical canters of India. People seek medical treatment and facilities which is either unavailable in their country or is highly expensive and unaffordable are attracted by the benefits of treatment in India. It is very important to consider the treatment options for pituitary tumours very carefully. India offers extremely talented surgeons and health professionals. All the major hospitals have highly experienced and internationally trained doctors who are adept in handling major treatment and surgeries including the Pituitary Tumour treatment and surgery. Cities offering bestPituitory Tumours Treatment and Surgery in India are;

Mumbai Hyderabad Kerala

Delhi Pune Goa

Bangalore Nagpur Jaipur

Chennai Gurgaon Chandigarh

Cost of Pituitary Tumours Treatment and Surgery in India:

India offers the most cost effective medical services in the world without compromising on the quality. This enables patients to regain control of their lives through opting for private overseas healthcare and surgery in India. Wide range of procedures is offered at the spotlessly clean hospitals. Surgeons speak English and are using the latest state of art hi-tech apparatus and technology. All surgery and treatments are tailored and developed to consider the needs of the travelling patient. India gives you the opportunity to have high class immediate surgical and medical treatments which includes Pituitary tumor treatment and surgery at low cost. The healthcare and surgery costs for pituitary tumours are lower than those found in other medical tourism destinations such as France, Belgium and Germany.

Some of the common countries from which patients travel to India for surgery are:

USA UK Canada

Australia New Zealand Nigeria

Kenya Ethiopia Uganda

Tanzania Zambia Congo

Sri Lanka Bangladesh Pakistan

Afghanistan Nepal Uzbekhistan

ABOUT INDIA

Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.

Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city.

Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world.

Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving.

Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India,

Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra.

Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet.

Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jam-packed burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors.

Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism.

Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India.

Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery.

Gurgaon – It is one of the four important satellite cities of the National Capital Region and is often referred to as the 'Millennium

Patients Testimonial:

Mrs.Okoh - Nigeria

Pituitary Tumour Surgery and Treatment in India

I am Mrs.Okoh from Nigeria I am telling about my unique experience of Pituitary macroadenoma surgery at Goa in India which

was given to me at a low cost as compared to that in US and UK. I was totally blank when my family doctor told me that I am

suffering from pituitary macroadenoma. Literally, It was very unfortunate. I was very depressed and wanted to get rid of the

deadly disease as soon as possible. After searching for online medical solutions I found the website of Dheeraj Bojwani

Consultants. Dr. Bojwani explained about the steps and procedure of the getting medical treatment in India. By talking with

him, I was sure that I was in safe hands. I got surgery dates from them after my medical visa approval. I flew to India with my

husband. We were taken to the hospital by the health associates of Dr. Bojwani they represented my medical case to he doctor

so well . The brain surgeon was trained from US and was a reputed medical professional. During my Pituitary macroadenoma

surgery at Goa in India I was able to save more money as Dr. Bojwani was kind to provide a cost reduction benefit during my

travel and medical lodging at the hospital. After my surgery It I felt in a better health I was feeling as If I have got a new life. I

was no more having the sensation of vomiting and all other symptoms of this disease. I was very happy that day. After my low

cost Pituitary macroadenoma surgery at Goa in India, I went to visit the beaches of Goa with my husband. We enjoyed very

much there. I am very much thankful to the whole staff and the surgeon for providing me precious support and care which I

really needed at that time during my Pituitary macroadenoma surgery at Goa in India.

Knee Replacement Surgery in India

Knee replacement surgery also known as knee arthroplasty is procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. The procedure has been proven to help individuals return back to moderately challenging activities such as golf, bicycling, and swimming. Total knees are not designed for jogging, or sports like tennis and skiing (although there certainly are people with total knee replacements that participate in such sports). Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

Knee Replacement Surgery Candidates A person would be considered a candidate for knee replacement if there is:

• Daily pain • The pain is severe enough to restrict work, recreation and ordinary activities of daily living

• Significant stiffness in the knee

• Significant instability (constant giving way) of the knee • Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee

• Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis

Success Rate of Knee Replacement Surgery: Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and allowed them to enjoy their golden years.

Knee Replacement Surgery Preparations:

• If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery.

• If you drink, don't have any alcohol for at least 48 hours before surgery.

• Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to strengthen your upper body will help you cope with crutches or a walker after surgery.

• Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery. This examination will assess your health and your risk for anesthesia. The results of this examination should be forwarded to your orthopaedic surgeon, along with a surgical clearance.

• Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and answer any last-minute questions.

• You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray.

• Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to stop taking certain medications or your surgeon may recommend substitute medications until your surgery. Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.