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From Misdiagnosis to a Miracle: Brain Tumor Surgery for a Belleville Resident Helps Start a Family

 

In 2020, Samantha Marak and her now-husband of Belleville, New Jersey, made a decision that millions of couples make every year: They wanted to start a family. In her mid-20s, Samantha was ready to embrace motherhood.

But by 2021, after a year of trying to conceive, something was clearly wrong. Her menstrual cycles stopped completely, and what should have been a time of hope and anticipation had become a source of growing concern and confusion.

When Answers Fell Short

After nine months without her period, Samantha went to her gynecologist and was told she had polycystic ovary syndrome (PCOS). Her doctor delivered devastating news: She might never be able to get pregnant.

Determined to take control of her health, she made lifestyle changes, taking vitamins and improving her diet. But years passed without any change, and by the time she and her husband married in 2023, the hope of having children felt increasingly distant.

Refusing to Give Up

Samantha’s husband encouraged her to keep seeking answers. Over the course of several months, she saw three more specialists who all confirmed the PCOS diagnosis and reiterated that she might not have children of her own.

Still, she refused to give up on her dream of becoming a mother. In September of 2024, she found a new OB-GYN who noticed something no one else had: elevated prolactin levels in her bloodwork. She referred Samantha to an endocrinologist.

The Truth Revealed

She had to wait several agonizing months to get an endocrinology appointment. The doctor ordered an MRI, which finally revealed the truth: a 0.5 centimeter pituitary adenoma – a non-cancerous tumor arising from her pituitary gland and secreting high levels of prolactin. This hormone inhibits the menstrual cycle and prevents pregnancy.

“I didn’t have a follow-up with the doctor for a few weeks, but I saw the report and knew I had a tumor,” Samantha recalled. “My world exploded.”

The endocrinologist prescribed cabergoline to try to shrink the tumor. While she had no symptoms before treatment, the medication came with terrible side effects. Migraines kept her bedridden and unable to work. Moreover, her prolactin levels didn’t budge.

Finding the Right Doctor

Finally, a family friend suggested that Samantha go to the renowned brain tumor center at Atlantic Health System. She went to the Atlantic Brain and Spine website and began researching neurosurgeons. One immediately stood out: Dr. Fabio A. Frisoli, a neurosurgeon specializing in complex brain tumors.

“I knew right away that I wanted to see Dr. Frisoli,” said Samantha. “He focused on pituitary tumors, and I just felt like he was the right fit.”

Those feelings were confirmed at her first appointment with Dr. Frisoli. He put her at ease, carefully outlining all her options without pressuring her to make any difficult decisions. Samantha was nervous about surgery, so he recommended she stay on the cabergoline and return in six months.

Two Steps Forward, One Step Back

Despite the tumor, Samantha and her husband forged forward with fertility treatments. She found a new endocrinologist specializing in reproductive medicine and began an intensive hormone regimen that left her physically and emotionally drained.

“I remember lying down on a booth at the restaurant where I work, crying from the pain and nausea,” Samantha recalled.

When blood tests revealed the medication wasn’t helping her hormone levels, the reproductive endocrinologist gently recommended that Samantha reconsider surgery. She and her husband visited several other neurosurgeons, but none made her feel as safe or understood as Dr. Frisoli.

She took the plunge and made the appointment for brain tumor surgery.

Trusting in the Experts

Samantha was terrified – she’d never had any type of surgery before, let alone brain surgery. She was greeted by her surgical team, including Dr. Frisoli and Dr. Giant Lin, the ENT sinus specialist who would be co-performing the procedure.

“They were laughing with me and made me feel much more confident and comfortable before surgery,” said Samantha. “I’m so happy I chose them.”

Together, Dr. Frisoli and Dr. Lin performed a minimally invasive endoscopic endonasal transsphenoidal resection of the tumor. This procedure is performed through the nose with the aid of a camera the size of a straw with no visible cuts or scars. The tumor is then meticulously dissected away from the normal pituitary gland with the assistance of neuronavigation—a GPS system for the brain—which provides MRI co-location within 1 millimeter of accuracy.

Healing and Hope

The operation was a success. “Thankfully, we were able to remove the entire tumor while avoiding any complications such as cerebrospinal fluid leakage, injury to the normal pituitary gland, or infection,” said Dr. Frisoli.

By the very next day, Samantha’s prolactin was back to normal. After years of elevated levels in the 50s, it had dropped to 1.0.

She went home after a weekend in the hospital, tired but relieved. The recovery was smooth. Beyond some initial head pain, nausea, and fatigue, Samantha felt noticeably better right away.

“I had a new outlook on life,” Samantha explained. “It felt like that part of me was gone, and I was a new person. It was a freeing feeling.”

Dr. Lin and Dr. Frisoli checked in on Samantha’s progress, and a follow-up MRI showed no evidence of recurrent or residual tumor.

A Future Restored

Exactly one month after surgery, Samantha got her first period in years. A month after that, she learned she was pregnant.

After years of misdiagnosis, debilitating symptoms, and ineffective treatments, Samantha finally achieved what she had wanted for so long—a chance at motherhood.

“After so many doctors telling me it wasn’t going to happen, and then having it happen naturally, is just amazing,” she said. “It feels like a miracle.”

About Atlantic Brain and Spine

Atlantic Brain and Spine is a New Jersey neurosurgical practice specializing in complex brain, spine, and neurovascular conditions.

The practice provides comprehensive care for conditions including brain tumors, aneurysms, epilepsy, and complex spine disorders, and serves communities across northern and central New Jersey. Offices are located in Morristown, Summit, New Brunswick, and Manalapan. A new location will soon open in Edison, New Jersey.

Learn more at AtlanticBrainAndSpine.org or call 973-993-7100.

FAQS

Pituitary Adenoma FAQ | Atlantic Brain and Spine

What is a pituitary adenoma?

A pituitary adenoma is a typically benign, slow-growing tumor that develops in the anterior portion of the pituitary gland, a small gland located at the base of the skull behind the nose. The pituitary gland is often referred to as the body’s “master gland” because it helps regulate hormone production throughout the endocrine system. Most pituitary adenomas are highly treatable and may be managed with medication, surgery, radiation therapy, or observation depending on the patient’s condition.

Where is the pituitary gland located?

The pituitary gland sits within a bony structure called the sella turcica at the base of the skull, just behind the nose. It is connected to the hypothalamus by a stalk that allows the brain to regulate hormone production and release.

Are pituitary adenomas cancerous?

Most pituitary adenomas are benign, meaning they are not cancerous. These tumors generally grow slowly and are often very treatable when appropriately diagnosed and managed.

What symptoms can a pituitary adenoma cause?

Many small pituitary adenomas cause no symptoms. When symptoms occur, they are usually related to either hormone imbalances or pressure from tumor growth on surrounding structures. Symptoms may include:

• Missed menstrual periods (amenorrhea)
• Infertility
• Breast milk production without pregnancy (galactorrhea)
• Abnormal growth or acromegaly
• Cushing’s syndrome
• Hyperthyroidism symptoms
• Fatigue and weakness
• Excessive thirst and urination
• Headaches
• Nausea and vomiting
• Vision changes or vision loss

How do hormone-producing pituitary tumors differ from other pituitary adenomas?

Some pituitary adenomas actively produce hormones and are called functioning tumors. These tumors often cause symptoms even when they are very small. Other tumors may not secrete hormones and can grow larger before they are discovered, sometimes causing symptoms due to pressure on nearby structures such as the optic nerves.

Can a pituitary adenoma affect vision?

Yes. As a pituitary adenoma enlarges, it may compress the optic nerves or optic chiasm. This pressure can lead to visual disturbances, impaired peripheral vision, or vision loss.

How are pituitary adenomas diagnosed at Atlantic Brain and Spine?

Diagnosis typically includes:

• A review of symptoms and medical history
• Physical examination
• Endocrine evaluation with specialized blood tests
• Ophthalmologic examination and visual field testing
• Advanced imaging studies such as MRI or CT scans

These evaluations help determine the tumor’s size, location, hormonal activity, and effects on surrounding structures.

Why are hormone tests important?

Hormone testing helps determine whether the pituitary gland is producing too much or too little of certain hormones. These results help physicians identify the type of pituitary tumor and develop the most appropriate treatment plan.

What imaging studies are used to evaluate pituitary adenomas?

Atlantic Brain and Spine commonly uses MRI and CT scans, often with contrast dye, to clearly visualize the tumor and surrounding anatomy. In some cases, high-resolution imaging may be used with frameless stereotactic guidance technology to assist with surgical planning.

Do all pituitary adenomas require treatment?

No. Some small benign pituitary tumors that are not causing symptoms or hormonal abnormalities may simply be monitored over time. Treatment may only become necessary if the tumor grows or begins causing symptoms.

Can medications treat a pituitary adenoma?

Yes. Certain pituitary tumors, particularly prolactin-producing tumors, may be treated successfully with medication alone. These medications can reduce tumor size and are often managed long-term with the guidance of an endocrinologist.

When is surgery recommended?

Surgery may be recommended when a pituitary adenoma is causing vision problems, hormone disturbances, significant growth, or compression of nearby structures. Treatment decisions are based on the tumor’s size, location, hormonal activity, and the patient’s overall health.

What type of pituitary tumor surgery does Atlantic Brain and Spine perform?

Atlantic Brain and Spine utilizes advanced endoscopic minimally invasive skull base techniques whenever appropriate. During this procedure, the neurosurgeon and an ENT surgeon access the tumor through the nose and natural sinus pathways, avoiding external incisions and openings in the skull. The goal is to remove as much of the tumor as safely possible while protecting surrounding critical structures.

What are the advantages of endoscopic pituitary surgery?

Potential benefits of endoscopic minimally invasive surgery include:

• No external skin incisions
• No skull opening
• Direct access through the nasal passages and sinuses
• Improved visualization of the surgical area
• Safer and more effective treatment for many pituitary adenomas and parasellar tumors

What happens after pituitary tumor surgery?

After surgery, the tumor tissue is examined under a microscope to confirm the diagnosis, evaluate recurrence risk, and help determine whether additional treatment may be needed.

Is radiation an option for treating pituitary adenomas?

Yes. Atlantic Brain and Spine may recommend stereotactic radiosurgery, including CyberKnife® or Gamma Knife®, for certain small tumors, residual tumors, tumors located in difficult-to-reach areas, or for patients who are not candidates for surgery. These treatments use precisely focused radiation beams to target the tumor while minimizing exposure to healthy tissue.

Why is a multidisciplinary approach important for pituitary adenoma treatment?

Because the pituitary gland regulates many important hormones throughout the body, treatment often requires coordinated care among neurosurgeons, endocrinologists, ENT skull base specialists, ophthalmologists, and radiation specialists. This collaborative approach helps optimize outcomes and long-term management.

When should I seek evaluation for a pituitary adenoma?

You should consider evaluation if you experience unexplained hormonal changes, infertility, missed periods, unusual growth changes, headaches, vision problems, excessive thirst and urination, or if imaging has identified a pituitary or parasellar tumor. Early diagnosis can help determine the most appropriate treatment strategy.

Source: Atlantic Brain and Spine – Pituitary and Parasellar Tumors, https://atlanticbrainandspine.org/condition/pituitary-and-parasellar-tumors/.