Cause and Effect

By Jessica Park

In July 2018, when Bria Arnel’s smart watch began sounding a frequent alert that her heart rate was extremely high, she says, “I thought maybe my watch wasn’t working properly.”

Bria, who grew up and lives in Jefferson City, and works for the Missouri Department of Economic Development, had never been seriously ill before, although she’d noticed some recent changes. She grew tired easily and began to sweat more than usual. She had also gained weight and noticed her face looked red. But she didn’t think it was anything serious.

“I was thinking I’m almost 40, so this could be early menopause,” she says. She had planned to talk to her OB/GYN about it at her next screening appointment. 

Then Bria’s smart watch began going off again, this time to tell her that her blood pressure was also too high. She immediately went to a clinic in Jefferson City, where she received medication to control her heart rate and blood pressure, along with a referral to Boone Medical Group to be seen by Michael Daly, DO. 

“My appointment was set up for the next day. It was really fast,” Bria says.

Dr. Daly ordered labs for Bria that revealed her cortisol levels were, in her words, “off the charts.” He then referred her to Sonya Addison, MD, an endocrinologist at Boone Medical Group Diabetes and Endocrine clinic, to find the cause of her increased cortisol.

Bria says Dr. Addison knew the cause immediately: “She took one look at me and she knew I had Cushing’s.”

Cushing’s syndrome, or hypercortisolism, is a hormonal disorder where the adrenal glands produce too much cortisol. The most common cause is a non-cancerous (or benign) tumor on the pituitary gland, located on the base of the brain, that makes the gland produce a hormone that makes the adrenal glands produce too much cortisol. Other causes include a history of oral or injectable corticosteroids, like prednisone; tumors in other endocrine glands; or another disease affecting the adrenal glands. In rare cases, Cushing’s syndrome can be inherited.

Cushing’s syndrome is rare but has a distinct set of symptoms, including facial redness, acne, fat pads on the back and shoulders and striae, red-purple marks similar to stretch marks on the abdomen and other parts of the body. Other symptoms include fatigue, weakness, excess sweating, menstrual irregularities, high blood pressure and bone loss. Some people with Cushing’s syndrome may have depression or irritability, though Bria says she didn’t have these symptoms. 

Without treatment, Cushing’s syndrome may lead to diabetes, hypertension, heart disease, or osteoporosis, which can cause weak bones that fracture easily.

Bria’s lab tests confirmed what was plain to her endocrinologist, but they still had to find the cause of her syndrome. She received an MRI at Boone Hospital Center, which revealed a tumor on her pituitary gland. 

“I was scared at first,” Bria says. “I’ve had colds and the flu before, but I’ve never actually been sick. When they say you have a tumor, you’re thinking the worst.” 

Bria met with Terry Ryan, MD, a neurosurgeon with Mid-Missouri Neurosurgery, who explained the treatment options. Dr. Ryan recommended she have surgery to remove the tumor. In most cases and with an experienced surgeon, surgery to remove a pituitary gland tumor, which is often done by going through the nose, is a successful option. 

“Dr. Ryan was really nice,” she says. “He called me twice to go over everything with me. Then he called me into his office and met with me and my husband. I was scared, because I’d never had surgery before, but Dr. Ryan eased my mind.” 

Bria’s husband, Jeff, also accompanied her in February 2019 when she came to Boone Hospital Center for her surgery. 

“He stayed at the hospital the entire time I was there,” she says. “He thought everyone at Boone was just great.”

Bria also appreciated the care and compassion she received from everyone at the hospital. She was nervous when she first arrived, but the pre-op staff who prepared her for surgery were thoughtful and explained what they were doing every step of the way.  

“I was in the ICU for two days, and the staff was just wonderful. When they checked in on me, they weren’t just coming in the room to make sure my blood pressure was okay. They had conversations with me, too. They got to know me as a person.”

Bria laughs, “I remember one ICU nurse telling me I looked too good for someone who just had brain surgery. I didn’t feel good, but I was glad to know I looked good!” 

Dr. Ryan also visited Bria after her surgery. In the recovery room, she remembers him telling her, “We’ve got it.” 

A follow-up MRI showed the surgery was successful. A benign 2-millimeter tumor had been removed from her pituitary gland. Bria will have another MRI in October and then a scan once a year for the next five years, to make sure the tumor doesn’t return. 

Bria was out of work for a month as she recovered from surgery – with help from Jeff – but has since resumed her favorite activities, which include spending time with her nieces, traveling with Jeff to Branson and following the Saint Louis Blues during their winning season. She feels better and enjoys having more energy. 

One thing Bria isn’t doing anymore: receiving health alerts from her smart watch. She’s been able to stop the medication for her heart rate and high blood pressure, too. 

“I want people to know about Cushing’s syndrome,” she says. “You might have the symptoms and – just like me – think it could be menopause, but it could be something else!”

Bria is grateful for the care she received from her team of Boone Hospital physicians, nurses and health care professionals. She says, “They all made sure that I was getting the best care that I needed. They were all looking out for me.”