Miss Diagnosis: ADD/ADHD

Saturday, December 19, 2009

ADD/ADHD

We saw the pediatrician yesterday for the ADD/ADHD evaluation. They had us fill out an evaluation prior to seeing the doctor. The doctor came in and went over the forms and said she definitely fits the profile for ADD. The scoring is in several different categories and Alex's number was extremely high in the "cognitive" category. I have been worried that Cushing's has caused Alex to have cognitive deficits and just hadn't gotten around to talking to anyone about it. There is research that acknowledges it's a known problem with kids who've had Cushing's. Anyway, especially with this considered in, Alex is being referred to an Educational Neuropsychologist for further evaluation.

The pediatrician in willing to prescribe Ritalin, but would prefer Alex have the testing done with this new guy first. If he can't get her in shortly we will go ahead and start Alex on Ritalin. Right now we are just waiting for him to call back.

So that's one more diagnosis to add to the mix, and maybe cognitive deficits as well? It never ends does it?

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Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.