In March 2020, college student Gianna Schembari, 23, began to battle an illness that she would later learn is an extremely rare disorder of the endocrine system, the body’s complex network of glands and organs which uses hormones to control critical functions such as metabolism, energy level, and the ability to respond to injury, stress, and mood.
“The most noticeable symptoms that happened that early were the significant weight gain, my mood swings,” recalls Ms. Schembari. “I just kind of started getting into a really depressive state. I would get these headaches and I would get heart palpitations. I mean, things just started getting worse very quickly.”
Eventually, an MRI revealed a small benign tumor, called a microadenoma, located on Gianna’s pituitary gland. That’s an indication of Cushing disease, a rare and serious disorder that affects only 10 to 15 people per million. With proper surgical or medical treatments, a person with Cushing can return to a healthier life — as was the case with Ms. Schembari after she met a team of experts in removing pituitary tumors at Miami Neuroscience Institute , part of Baptist Health.
(Watch video and hear from patient Gianna Schembari and her surgical team: Neurosurgeon Vitaly Siomin, M.D., Miami Neuroscience Institute, and Francisco Pernas, M.D., an ENT (ear, nose and throat specialist) affiliated with Baptist Health. Video by Carol Higgins.)
“The pituitary gland is one of the most critical parts of the brain and I would picture it as a command center that would produce the critical hormones and send them to the bloodstream,” explains neurosurgeon Vitaly Siomin, M.D.  “Cushing’s disease is a condition when one of the hormones, which is called ACTH, is produced in excessive quantities.”
Once in the bloodstream, the ACTH hormone stimulates different organs of the body, and patients “may present clinically with high blood pressure and with some fat deposition in a very abnormal way. Some patients may decompensate and develop diabetes. The immune response is altered. They may develop brittle bones, pimples on the face and other problems.”
Medication to help shrink the tumor presented severe side effects.
“It made me very, very sick,” said Ms. Schembari. “I could not function. I was in bed. We were just like: Okay, maybe we need to go ask somebody else what they think.”
Ms. Schembari and her family then turned to neurosurgeon, Michael McDermott, M.D.,  chief medical executive at Miami Neuroscience Institute . A multi-specialty team of physicians experienced in the treatment of pituitary tumors was assembled for her case, including neurosurgeon Vitaly Siomin, M.D. and Francisco Pernas, M.D.,  an ENT (ear, nose and throat specialist) or otolaryngologist, affiliated with Baptist Hospital and other Baptist Health facilities.
“When I met with the team of all of my different doctors, I just instantly felt like everything was going to be okay,” said Ms. Schembari. “They knew exactly what it was and then they just had their plan as to the treatment.”
Dr. Pernas emphasizes the importance of the team approach at Miami Neuroscience Institute. “Some neurosurgeons will do the surgery on their own,” he said. “The difficulty becomes in the nasal anatomy. We as ENTs are skilled at nasal anatomy, and we’re skilled at nasal endoscopy.”
Dr. Siomin explains how technology has helped advance the removal of pituitary tumors via minimally invasive techniques.
“We could put the scopes through the nostrils and navigate the scopes using what’s called the image guidance technology,” says Dr. Siomin. “It is just like GPS that most people use for driving. We use the same technology for surgery that helps us to go directly to the tumor, open up very minimally and resect the tumor using the endoscopic visualization.
Ms. Schembari recalls her condition before the surgery. “I had high blood pressure, anxiety, panic attacks, nausea, vomiting — all that stuff and I was on about five medications.” But now, she is on track to a full recovery. “Since the surgery, I am not on one medication and all of those symptoms are completely resolved,” she says. “It’s been about seven months since the surgery and I feel amazing.”
Says Dr. Siomin of the pituitary tumor: “It’s all gone. And she has normal pituitary gland tissue.”
To say that Ms. Schembari is grateful is a huge understatement: “They are the best doctors on earth. I feel like a whole new person. I basically got my life back and I’m super, super happy.”