It was a first of its kind for the Cayman Islands, brain surgery that required no incision.  Fittingly, Dr. “James” Akinwunmi completed the surgery on his patient on the nation’s holiday, National Heroes Day.  For the patient, Dr. James and the team of nurses were performing what seemed like an act of heroism—brain surgery with no incision, no cuts, no saws, and no screws.  Dr. James shared, “We are very pleased with the results of the required observational scans reviewing the results of the surgery, three months post-operatively.  These have proven the surgery a success for our patient.  This is something that we do rather often in England, with such a large population there. In Cayman, it is a rather rare surgical procedure.”

Dr Eugene Foley ophthalmic Surgeon with the complaint of visual disturbance referred the patient to Dr. Akinwunmi and who made the initial diagnosis of a pituitary tumor. Dr Akinwunmi in turn asked Dr Hislop-Chestnut to manage the hormonal implications associated with pituitary tumours.

Dr. Hislop-Chestnut specializes in internal medicine, diabetes and endocrinology at her Grand Harbour Medical Centre location. The patient suffered from a Pituitary Adenoma, which is a benign tumor of the pituitary gland. The tumor had grown very large in size and was putting pressure on her optic nerve.  She explained, “My vision was really bad on the sides, I kept bumping into things…and I had these terrible headaches.”  Dr. James followed up, “One of the key factors in the patient/doctor dialogue that leads to further testing for proper diagnosis in this condition is the knowledge that the patient keeps bumping into things or hitting things.  It’s actually the loss of their peripheral vision.”


Patient Before

Patient Before

Patient After

Patient After

Together, Dr. James and Dr. Hislop-Chestnut are able to treat patients that have these types of tumors, which do not always need surgery, explains Dr. James, “Often times the patients may put off seeing their endocrinologist out of fear they will need surgery, when in fact their condition maybe treated with medication and clinical observation.  It is only in certain cases that we need to perform a surgical procedure.”

Common Symptoms of Pituitary Adenomas are:

  • Headaches
  • Vision problems that cannot be easily explained
  • Menstrual cycle changes in women
  • Mood swings or behavior changes
  • Erectile dysfunction
  • Weight change
  • Infertility
  • Excessive growth

Diagnosis of an adenoma:

Blood and urine tests to measure hormone levels and medical imaging provide the best means of diagnosing pituitary tumors. Diagnostic imaging will include a high-resolution, T1 weighted, gadolinium enhanced MRI. In addition, blood and urine tests to obtain endocrine diagnostics are required.

Treatment of an adenoma:

Specific treatment for adenomas can be coordinated by Dr. James Akinwunmi, Neurosurgeon at CTMH and the HSA and Dr. Diane Hislop-Chestnut, Endocrinologist (hormonal disorder specialist), Grand Harbor Medical Center. Treatment may include surgery, which usually requires surgical removal via a procedure called endonasal transsphenoidal endoscopic surgery, medical therapy, hormone therapy, and/or observation.