Travis lived an active lifestyle, regularly training for triathlons and weight lifting. In 2019, Travis started to gain weight and experienced a lack of energy and daily fatigue. Combined with his sudden lack of drive and inability to recover in between workouts, Travis went to his primary care provider for answers.

Bloodwork confirmed that Travis had low testosterone. His primary care provider then referred him to a urologist. Additional bloodwork made the urologist suspect that a tumor could be causing the low testosterone, and Travis was referred to a neurosurgeon. An MRI confirmed the presence of a pituitary tumor, and Travis was then referred to the UNC Pituitary Tumor Center for treatment in April 2023.

The pituitary gland is located at the base of the brain and controls hormones throughout the body. Pituitary tumors can disrupt hormone production and can often go undetected for years. For Travis, his tumor was disrupting his testosterone levels causing his excessive weight gain, fatigue, and lack of motivation.

“The tumor is literally in the middle of the brain in a very tight, densely packed space surrounded by critical brain structures involved with blood supply of the brain, vision, hormone balance, and a host of metabolic functions essential for life.”

The UNC Pituitary Center offers streamlined care for patients with pituitary conditions, and provides comprehensive care combined with state-of-the-art diagnostic and therapeutic services through multidisciplinary collaboration. The center is led by world-renowned pituitary tumor surgeon and Chair of the Department of Neurosurgery at UNC Health, Dr. Nelson Oyesiku, who has performed over 4,000 pituitary tumor surgeries.

During his first appointment with Dr. Oyesiku, Travis was told that he had a craniopharyngioma, a rare, benign tumor on his pituitary gland. Craniopharyngiomas often involve the pituitary stalk, which connects the pituitary to the brain and transmits signals from an area of the brain called the hypothalamus to the pituitary gland. Since the hypothalamus is involved in appetite and body weight regulation, many patients develop a condition called hypothalamic obesity.

Dr. Oyesiku explained to Travis that for his specific case, the pituitary stalk would need to be removed in order to successfully remove the entire tumor. “Craniopharyngiomas are very difficult tumors to treat surgically,” said Dr. Oyesiku. “The tumor is literally in the middle of the brain in a very tight, densely packed space surrounded by critical brain structures involved with blood supply of the brain, vision, hormone balance, and a host of metabolic functions essential for life.”

“Dr. Kargi was very clear on what it would take to manage my care.”

Dr. Oyesiku explained his surgical plan to remove the tumor to Travis, and the benefits and risks of the surgery. “He was very clear about the diagnosis and upfront about what it would take to correct it,” said Travis. “He told me it would be an invasive, high-risk surgery. I had a lot of questions and he answered every single one.”

During his first visit to the UNC Pituitary Center, Travis also met with endocrinologist and co-director of the UNC Pituitary Center, Dr. Atil Kargi. Dr. Kargi explained that after surgery, there would be a sudden drop in production of several hormones. This condition is called hypopituitarism. “He was very down to earth and very caring,” said Travis. “Dr. Kargi was very clear on what it would take to manage my care.”

On April 24, 2023 Travis went in for an 8-hour surgery to remove the pituitary tumor. The procedure is known as an endoscope, endonasal, transsphenoidal resection of a craniopharyngioma, and is done under general anesthesia. The surgical approach provides a minimally invasive, direct route through the nasal passage on both sides to the sinus at the back of the nose and then into the skull base, which is the gateway to the pituitary gland. Using an instrument called an endoscope that provides illumination, magnification, and fine surgical instruments, the surgeon can gain access to the tumor, and can identify and protect the critical structures in the region.

After his surgery, Travis stayed in the hospital for 10 days. “I couldn’t have asked for a better care team or better resources,” said Travis. “Dr. Oyesiku came nearly every day to check in and it was the highlight of my stay getting his updates.”

A week after discharge, Travis started his postoperative endocrinology management with Dr. Kargi. It took almost a year for Travis to get back to his “normal” through adjusting his medications. Endocrinology management after surgery is different for every patient and takes time and effort to adjust all hormone medications carefully, observe responses, and then readjust medications. “The issue with this disease is that normally the hypothalamus and pituitary gland work together as a gauge of normal hormone levels and when that gauge is broken, it becomes challenging to know the exact doses or hormone levels to target, or the set points, for each hormone for each individual patient,” said Dr. Kargi. “It is one of the most tedious and difficult things to do as an endocrinologist.”

Travis needed five different hormone medications to replace the hormone deficiencies after surgery. “This acute change of hormones and need to start many medications in a short period of time can be overwhelming for even the most resilient, resourceful, and prepared patients and medical teams,” said Dr. Kargi.

“I feel better now than I ever have. I couldn’t ask for anything better.”

Frequent blood tests, appointments, and careful attention to specific symptoms are crucial to a patient’s recovery. “One reason Travis has done so well is that he is a great patient,” said Dr. Kargi. “He is on top of things and always follows up and asks questions and takes his medications and does his labs,” said Dr. Kargi.

Dysfunction of Travis’s hypothalamus caused him to develop hypothalamic obesity (HO), which caused dramatic weight gain after the tumor was removed, despite aggressive hormone replacement. Travis was treated with a nutritionist and exercise program and a weekly injection. “I meet with Dr. Kargi every quarter,” said Travis. “He’s fantastic.”

Now, Travis is back at work full time and back to his active lifestyle. He’s working out and noted a significant improvement in his strength. He is still working to lose weight, but is no longer gaining weight like he was before his surgery and his energy has returned. “Overall, I feel better than I did pre-surgery,” said Travis. “I feel better now than I ever have. I couldn’t ask for anything better.”