“Dad, after you go to the doctor, will you be able to play with me more?”

For two years, Arnulfo experienced a gradual decrease in his eye sight, specifically his peripheral vision. He thought that the vision change was due to aging. But Arnulfo continued to struggle with his worsening eyesight, especially while playing tennis. “I kept missing the ball,” said Arnulfo. “I realized that I could not see the ball.”

Arnulfo had been wearing glasses for 15 years and went to his eye doctor to see if he was a candidate for Lasik surgery. After meeting with several specialists, he was referred to a neurosurgeon. “She looked at my eyes and said ‘you need to go see a neurosurgeon, it’s not your eyes,’” recalled Arnulfo. “She told me I could have a tumor.”

Two weeks later, an MRI confirmed the presence of a brain tumor, a large prolactinoma that was causing vision loss due to pressure on the optic nerve and hypopituitarism. Arnulfo then met with UNC Health neurosurgeon, Dr. Carlos David, to discuss surgical options to remove the tumor.

Arnulfo’s wife accompanied him to his appointment with Dr. David. She noted many changes that she had observed over the past couple of years including her husband’s lack of energy and motivation, his frequent headaches and migraines, and his thinning hair. These are all symptoms of a tumor near the pituitary gland. “Dr. David was very knowledgeable and answered all of my questions,” said Arnulfo.

Arnulfo’s wife was not the only family member who noticed his lack of energy. His two young children also noticed that his dad no longer had the energy to play. “One thing that got me was my son coming up to me saying ‘are you going to be able to play with me more’ after I told him that I was going to the doctor,” recalled Arnulfo. “I was unaware of how bad it was.”

Dr. David ordered labs that came back indicating that Arnulfo’s tumor was of the subtype that can be successfully treated with medications. After consulting with Dr. David, Arnulfo was told that he would not need surgery to remove the tumor, and Dr. David arranged a consultation visit for Arnulfo to meet with UNC Health clinical endocrinologist, Dr. Atil Kargi.

“While most men with low testosterone do not have pituitary tumors, when testosterone is very low, additional evaluation should be done to elucidate the cause.”

Arnulfo met with Dr. Kargi who prescribed several medications to help shrink the tumor and manage the symptoms caused by hypopituitarism. “Dr. Kargi went through everything thoroughly,” said Arnulfo. “He told me each of the medications and what they would do. He is very helpful and always responds in a timely manner.”

Dr. Kargi specializes in diseases of the pituitary gland including pituitary tumors, hypopituitarism, Cushing’s disease, prolactinoma, and more. He currently serves as the co-director of the UNC Pituitary Tumor Center. “A prolactinoma is the only type of tumor that shrinks so much with medication that we usually forego surgery and try medications first,” said Dr. Kargi. “Most patients never need surgery since they respond well to the medication.”

Dr. Kargi also explained the cause of Arnulfo’s lack of energy was due to low levels of testosterone caused by the tumor. “Prolactin lowers testosterone, so, a very common way that these men get diagnosed is from symptoms of low testosterone which include fatigue and weakness,” said Dr. Kargi. “While most men with low testosterone do not have pituitary tumors, when testosterone is very low, additional evaluation should be done to elucidate the cause.”

“For me, it was pretty quick. From the point I was diagnosed to the point when I got the medications, I really appreciated that. Especially now seeing the results.”

In December of 2023, Arnulfo started medication to shrink the tumor. In April of 2024, just four months after starting his medication, an MRI showed that Arnulfo’s tumor had shrunk to half of its original size.

Within a month of starting the medication, Arnulfo noticed a drastic improvement in his vision and no longer experienced regular headaches since the tumor was no longer pushing on the optic nerve. The medication also helped manage his symptoms caused by hypopituitarism, restoring his energy level.

Arnulfo is back to playing tennis, noting that the medication made a dramatic improvement to his peripheral vision. He loves to get outside with his family and play with his children. “I liked the response time at UNC,” said Arnulfo. “For me, it was pretty quick. From the point I was diagnosed to the point when I got the medications, I really appreciated that. Especially now seeing the results.”

Arnulfo was also very impressed by Dr. Kargi’s knowledge of the medications that he prescribed. “He is very knowledgeable and went through everything thoroughly,” said Arnulfo. “He told me what each of the medications would do. He is very helpful.”

Now, Arnulfo is hopeful that by sharing his story, he can motivate others to take control of their health, and not dismiss feeling unwell as signs of aging. He has encouraged his parents and wife to go in for their annual physicals. “One thing I learned was to go and get a check-up at least once a year,” said Arnulfo. “It’s better to figure it out instead of waiting.”

 

Article by: Makenzie Hardy, Marketing Coordinator, UNC Health Department of Neurosurgery