尼尔·奥森伯格的情况很糟糕. At age 42, he had rapidly gained weight and was up to 267 pounds. 他的脸又圆又肿. He’d developed a “beer belly” that was deeply etched with purple stretch marks.

更糟糕的是, a mystifying assortment of medical conditions was plaguing the formerly healthy Marylander: Frequent falls that shattered his suddenly-fragile bones. 血压飙升. 使人衰弱的疲劳，神经疼痛和肌肉衰弱. 尼尔需要一根手杖才能走路. 然后是助行器，最后是轮椅.

就连他的免疫系统似乎也变弱了. Neale was getting one infection after another—some of them serious. “If I got a little cold, it seemed to last forever,” Neale recalls. “Small cuts would get infected—one on my foot turned into 蜂窝织炎.”

In December 2015, unable to walk on his own, Neale reluctantly quit his brewery job.

诊断:库欣综合征 

Looking at 尼尔的 high blood sugar, one doctor diagnosed 糖尿病, which accounted for some of his issues but left many others unexplained. 尼尔很幸运, 另一个医生, 一个内科医生, looked at 尼尔的 assortment of problems and recognized the classic signs of 库欣综合症. She referred Neale to a specialist at Johns Hopkins: endocrinologist 罗伯托·塞尔瓦托里，m.s.D.

什么是库欣综合征?

库欣综合症 (named after the famed Johns Hopkins surgeon Harvey Cushing (1869 - 1939) is an endocrine problem, 一个与腺体和荷尔蒙有关的. For reasons yet to be discovered, women are nine times more likely than men to develop it.

事情是这样的:肾上腺, 哪个位于肾脏上方, receive a chemical signal called ACTH from the pituitary gland, 哪一个生活在大脑的中心深处. ACTH tells the adrenal glands to produce a hormone called cortisol. 过多的ACTH会使肾上腺超负荷运转, 让人的整个身体系统充满皮质醇. The cause can be a tumor on the adrenal gland or on the pituitary gland.

That extra cortisol was causing 尼尔的 high blood sugar, 高血压, 骨骼和肌肉无力, 免疫系统减弱, swollen stomach and upper body—even the stretch marks on his stomach.

Salvatori says, “One hundred percent of 尼尔的 problems were due to his Cushing. Sometimes this disease is hard to diagnose, but he had a very obvious constellation of syndromes.”

Soon after meeting with Salvatori, Neale experienced congestive 心脏衰竭这是库欣综合征的另一种并发症. He had to be raced to a nearby hospital by ambulance; he was too sick to survive the trip just a few more miles to reach The Johns Hopkins Hospital. 控制库欣氏病变得至关重要. 

垂体瘤:问题的根源

In 尼尔的 case, 库欣综合症 was due to too much ACTH production in his body. To save 尼尔的 life, the doctors had to find out where the excessive ACTH was coming from.

“当我们看到如此严重的库欣综合征时, 我们想到一个肿瘤, 通常发生在大脑外的,萨尔瓦托里说. 多种肿瘤可自行产生ACTH.

尼尔的 核磁共振成像扫描 看起来正常. But a special test that analyzed blood flowing at the base of 尼尔的 skull revealed that the excess ACTH was coming from the pituitary area.

Salvatori knew there was a pituitary tumor; the task was to find it. He called upon the Pituitary Center's surgical director, neurosurgeon 加里·加利亚，m.s.D. 使用他自己发明的成像技术, Gallia was able to locate an adenoma 尼尔脑垂体上的肿瘤 that was pumping out ACTH. Surgery to remove it was the only thing that could reverse 尼尔的 rapidly deteriorating health.

关键的合作

肿瘤很小——小于1英寸.4厘米. 但它缠绕在颈动脉上, the large vessel that supplies blood to the head and brain. 切除肿瘤既危险又困难.

萨尔瓦托里说，“我的医生. 加利亚不得不从帽子里变出一只兔子. We estimated we would only be able to remove 70 percent to 80 percent of the tumor.”

手术于2016年3月进行. The first attempt was canceled when Neale came down with a sinus infection. 但这一天终于到来了. 头颈外科医生 Masaru Ishii, M.D., worked with Gallia on accessing the deeply-embedded tumor.

Exceptional skills, a good plan, and a touch of luck won the day. 石井通向脑下垂体的通道很清晰, Gallia was able to access the area and gently unwrap the tumor from around the carotid artery and remove it. 尽管困难重重，他还是成功了.

逐步康复，感恩的态度

垂体瘤切除后, Neale still had a way to go before his body could start returning to normal. His body had gone from making too much cortisol to suddenly none at all, 必须恢复正常的平衡.

The excess cortisol coursing through his body over the years had left him weak and depleted. Just after pituitary surgery he had another fall and broke his spine, 需要再做一次手术.

萨尔瓦托利说:“尼尔经历了很多. 他极度虚弱. But he has a positive attitude and got a lot of support from his family.”

尼尔非常感谢约翰霍普金斯大学的整个团队. “外科医生救了我的命，”他说. “没有他们的帮助，我现在已经死了. I was in the ICU for four or five days, and the nurses took great care of me. 物理治疗和职业治疗都很棒.”

He’s still working hard at getting his strength back and continuing with physical therapy. He’s lost 107 pounds and says he’s back to his high school weight. 他的腿还很虚弱，还不能跑. 但是他会爬楼梯, 沿着这条街走，然后开车, all of which were impossible without assistance before his surgery.

2017年5月, 尼尔参加了他第25次高中同学聚会, reconnecting with longtime friends who’d supported him throughout his ordeal. He has his sights set on eventually getting back to full-time employment.

“我现在44岁了，”他说. “It’s been challenging, but I’m ready to get back to being Neale again.

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