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Amy Ford Birthday 2013
Amy Ford Birthday 2015
Amy R Ford 9-12-2025 Candidate for further discovery regarding the cause and remediation of Cushing’s Syndrome/Cushing’s Disease.
Amy R Ford 11059 East Startender Place Tucson, AZ 85749 520-241-2854 amyfordaz@gmail.com
AMY R Ford
Patient Details: by David Skinner MD
AMY R Ford
Dutch Plus
AMY R Ford
AMY R Ford -history of attempts to understand the cause of Amy’s condition 2022, 2023 and 2025
AMY R Ford
Center for Neurosciences 8-2-2022
AMY R Ford
MRI Brain 6-21-2024 MRI Brain 6-12-2025
06-12-2025 4:24 PM
Fax Services
RA13631752 Alena Johnson
Radiology Ltd.
Radiology Ltd. - La Cholla Tucson, AZ 85741
Phone: (520)733-7226
5960 N. La Cholla Blvd.
ACC: RA13631752
Patient: FORD, AMY R DOB: 05/15/1945 Requesting Provider: Johnson, Alena M, FNPC
MRN: 000034203
DATE OF EXAM: 06/12/2025
EXAMINATION: MR Head Pituitary without and with contrast
CLINICAL INDICATION: Cushing's syndrome.
TECHNIQUE: A combination of FLAIR, T1, T2-, diffusion-, and post gadolinium (7 mL of Dotarem, with 8 mL discarded) T1- weighted images of the head were obtained in multiple imaging planes. Thin-section sagittal and coronal T1-weighted, coronal T2-weighted, and post-gadolinium fat-suppressed T1-weighted images of the pituitary were also performed. The contrast amount documented is the total amount given for all exams that were performed contemporaneously.
COMPARISON: CT head, 06/13/2022, Tucson Medical Center.
FINDINGS: BRAIN PARENCHYMA: No evidence of hemorrhage, mass, or acute infarction. No abnormal enhancement. Mild burden of T2 FLAIR hyperintensities scattered throughout the supratentorial white matter, compatible with sequela of chronic microvascular disease. There is a cystic lesion of the left hypothalamus measuring 5 x 4 mm, with mild mass effect upon the left mamillary body. No associated enhancement or abnormal T2 FLAIR signal. This is most likely a prominent perivascular space or potentially a tiny neuroglial cyst, doubtful clinical significance. Mild/moderate generalized volume loss.
EXTRAAXIAL SPACES/VENTRICULAR SYSTEM: Enlarged ventricles and sulci, commensurate with volume loss. No hydrocephalus. No extra-axial fluid collection. No midline shift /herniation.
SELLAR/SUPRASELLAR REGION: Unremarkable pituitary gland, infundibulum, optic chiasm, cavernous sinuses, and adjacent structures. No evidence of pituitary adenoma.
OTHER: Small left-sided mastoid air cell effusion. Prior orbital lens surgeries. A few tiny paranasal sinus mucosal retention cysts.
IMPRESSION: 1. No acute intracranial abnormality. 2. No evidence of pituitary adenoma. 3. Mild senescent changes of the brain, with mild chronic microvascular disease. 4. Small left-sided mastoid air cell effusion.
Electronically signed by Samuel Rogers M.D., Neuroradiologist
Dictated: 6/12/2025 3:45 PM Signed: 6/12/2025 3:52 PM
FINAL REPORT
The information contained in this report is CONFIDENTIAL and/or LEGALLY PRIVILEGED information întended only for the use of the individual/s named above. If you have received this communication in error, immediately notify us by telephone 844-754-1507. Thank you.
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AMY R Ford
CT Scan 5-16-2025 Abdomen and Pelvis
AMY R Ford
Diagnos Techs 10-14-2024
AMY R Ford
Protein Spike 5-13-2025
AMY R Ford
Recently Purchased Medication
AMY R Ford
Possibly the Hypothalamus 9-10-2025
Another possibility as alerted by Roksolyana R Tourkevich MD Noticed when reading the MRI of 6-12-2025 of Amy’s head, a cystic lesion of the left hypothalamus measuring 5x4mm, with mild mass effect upon the left mamillary body. The hypothalamus sits at the heart of this puzzle. It’s a small but critically important region, tucked deep in the brain, just above the pituitary gland. You can think of it as the “master regulator” that tells the pituitary what to do—and by extension, it influences nearly every hormone system in the body…. Directs the body’s chemical factory Here’s a breakdown of its main functions and why a cystic lesion of the left hypothalamus measuring 5x4mm, with mild mass effect upon the left mamillary body could be significant for Amy. o The hypothalamus produces “releasing” and “inhibiting” hormones that tell the pituitary gland to either produce or hold back its hormones. o This impacts stress hormones (cortisol via ACTH), thyroid hormones (energy/metabolism), growth hormone, reproductive hormones (LH, FSH), and more. 2. Autonomic Nervous System Control o Helps regulate heart rate, blood pressure, and breathing rhythms. o This may explain episodes of racing heart, anxiety surges, or sudden weakness. 3. Homeostasis (Body Balance) o Maintains body temperature, hunger/thirst, and sleep–wake cycles. o Disruptions can cause dizziness, fatigue, poor sleep, and feelings of imbalance. 꾆 Core Functions of the Hypothalamus 1. Endocrine Regulation (Hormones)
4. Circadian Rhythm Control o The hypothalamus (especially the suprachiasmatic nucleus) is the brain’s “clock.” o Dysregulation here can explain early-morning cortisol spikes, disrupted sleep, and AM anxiety symptoms you’ve described before. 꾆 What Happens if Something Presses on the Hypothalamus Because it’s such a small structure surrounded by critical pathways, even a small lesion, cyst, or growth can cause broad symptoms. Possible effects and preciously Amy’s Symptoms include: • Hormonal irregularities (mimicking pituitary disorders like Cushing’s, even if tests look “normal”). • Autonomic disturbances : sudden changes in heart rate, dizziness, sweating, or feeling faint. Amy’s Autonomic disturbances occur between 2 and 5 AM • Sleep-wake disruption : unusual cortisol surges, nighttime awakenings, or early-morning panic. Amy’s symptoms occur between 2 and 5 AM • Balance/coordination issues : nearby structures also integrate with movement control. Amy who has always had terrific balance now suffers balance issues 꾆 Why Another MRI Could Matter • Lesions in this area can be small or slow-growing, sometimes missed or overlooked on earlier imaging. • A repeat MRI, ideally with high-resolution pituitary/hypothalamic protocol , and thin slice may reveal subtle changes. • a cystic lesion of the left hypothalamus measuring 5x4mm, with mild mass effect upon the left mamillary body could be significant for Amy and it could finally explain Amy’s mix of unexplained systemic symptoms (endocrine, autonomic, circadian).
꾆 Takeaway Even though Barrow ruled out pituitary-driven Cushing’s, the hypothalamus above it could be the root. A compressive effect there could produce symptoms that look endocrine, neurologic, and autonomic all at once— which perfectly matches Amy’s profile.
These are the main categories of conditions that can affect the hypothalamus and potentially explain Amy’s symptoms.
꾆 Conditions That Can Affect the Hypothalamus 1. Tumors, Cysts & Growths • Craniopharyngioma – benign, slow-growing tumor that often arises near the hypothalamus/pituitary stalk; can press on surrounding structures. • Hypothalamic or Optic Glioma – more common in younger people but can occur in adults; may cause vision problems and hormonal disturbances. • Meningioma – benign tumor of the meninges that can grow near the hypothalamus. 2. Cysts & Benign Lesions • Rathke’s Cleft Cyst – benign fluid-filled cyst in the pituitary region, sometimes compressing the hypothalamus. • Arachnoid Cyst – cerebrospinal-fluid filled sac that can form near the hypothalamus. • Colloid Cyst (of the third ventricle) – rare but can press on the hypothalamus and cause sudden dizziness, headaches, or balance issues.
3. Vascular Issues • Aneurysm (especially of nearby arteries like the Circle of Willis) can compress hypothalamic structures. • Cavernous malformations / vascular malformations – tangles of abnormal vessels that sometimes cause pressure or small bleeds. • Stroke (ischemic or hemorrhagic in diencephalic area) – can damage hypothalamic nuclei and disrupt regulation. 4. Inflammatory / Autoimmune • Sarcoidosis – can infiltrate hypothalamic tissue. • Hypophysitis (inflammation of the pituitary stalk/hypothalamus region, sometimes autoimmune or drug-induced). 5. Functional / Non-structural Disorders • Hypothalamic dysfunction without a visible lesion – sometimes due to chronic stress, severe sleep disruption, or metabolic conditions. • This could explain symptoms even if no mass is found on MRI. 꾆 Symptoms That Point Toward Hypothalamic Involvement • Endocrine changes (weight shifts, heat/cold intolerance, abnormal cortisol cycles). • Autonomic issues (heart racing, dizziness, sweats, blood pressure swings). • Sleep/circadian disruption (early AM wake-ups, cortisol surges). • Behavioral/emotional changes (anxiety surges, fatigue).
• Balance/coordination issues (due to nearby brain structures).
踰踱踲踳 The repeat MRI with attention to the hypothalamus and pituitary stalk will be key. Here’s a practical checklist of questions you and Amy can take into the MRI review appointment. Hope we can have both a Barrow and Mayo appointment. These will help make sure the radiologist/neurologist looks closely at the hypothalamus and explains things clearly: 꾆 Questions to Ask prior to and after Amy’s Hypothalamus MRI 1. About the Imaging Quality • Will this MRI be done with a dedicated pituitary/hypothalamic protocol (thin slices, high resolution, with and without contrast)? • Do you recommend any additional imaging (e.g., 3 Tesla MRI , functional MRI, or CT angiography if vascular compression is suspected)? 2. About Structural Findings • Do you see any lesion, cyst, tumor, or abnormal growth near the hypothalamus or pituitary stalk? • If yes, how large is it, where exactly is it located, and is it pressing on the hypothalamus ? • Is there any change compared to her prior two MRIs? (Growth, shrinkage, new findings?) • Do you see any signs of compression of nearby structures (optic chiasm, third ventricle, pituitary stalk)?
3. About Functional Impact
• Could what you see on the MRI explain Amy’s symptoms (anxiety surges, dizziness, balance issues, early AM cortisol surges)? • Is there evidence of fluid build-up (hydrocephalus) , pressure on the third ventricle, or any shift in brain structures? • Are there any vascular abnormalities (aneurysm, malformation) near the hypothalamus that could mimic a mass effect? 4. About Next Steps • Should she see a neuroendocrinologist (specialist in brain– hormone interactions) or neurosurgeon if something is compressing the hypothalamus?
茦茧茨茩茪茫 Amy’s Gentle Question Guide Understanding the Diagnosis
1. What exactly is pressing on my hypothalamus? 2. Is it benign, and how certain are we from the MRI? 3. Does it need treatment right away, or can we monitor it safely? Treatment & Options 4. Which approach do you recommend, and why? 5. What’s the main goal of treatment — to remove, shrink, or just relieve pressure? Safety & Recovery 6. What are the risks of surgery or treatment, and how do you minimize them? 7. How will treatment affect my daily life — recovery time, fatigue, or hormone changes?
Comfort & Confidence 10.
How many times has your team performed this procedure? Can you show me an animation or diagram of the approach you’d use? 12. What support is available afterward (rehab, hormone monitoring, counseling)? 11.
膆 Tip for Amy : If a medical answer feels overwhelming, pause and ask: Specific Treatment Type Amy and Rodger prefer for Hypothalamic Lesions
Animation of how laser thermal ablation (LITT) or similar stereotactic (guided) biopsies/treatments work. Though not always specific to hypothalamic location, it shows minimally invasive treatment of deep brain lesions. MedicalGraphics
Gentle animation, fewer graphic details. Probably good
3D animation stereotactic neurosurgery / LITT MedicalGraphics
for initial viewing.
Specific Treatment Type Amy and Rodger prefer for Hypothalamic Lesions
A thin probe is placed via a small opening (stereotactic guidance) into the lesion; heat is applied to destroy or shrink the lesion. Good for deep or hard-to-reach locations with less disruption of normal brain tissue.
Laser interstitial
Precise placement required; risk of heat injury to nearby sensitive areas; imaging and monitoring essential.
thermal therapy (LITT)
Referrals Please Contact Info
Neurosurgery / LITT- relevant Contacts • Main Neurosurgery clinic phone: (602) 406-
Notes on Portals / How to Send Imaging
Center
• Barrow Patient Portal via Dignity Health My Portal; you can request second opinions, send records, imaging. Barrow Neurological Institute+2Barrow Neurological Institute+2 • For surgical evaluation, they prefer imaging & medical records before the first appointment. Barrow Brain and Spine+1 providers/referrals, which allows upload of records, imaging, test reports and follow progress. Mayo Clinic+1 • You can request an appointment directly; bring imaging & reports (CDs or DICOMs) to the consultation. Mayo also has good info about LITT usage in Phoenix as a minimally invasive option. Mayo Clinic+1 • Mayo Clinic provides a secure referral portal (CareLink) for
3181 Barrow Neurological Institute+2Barrow
Barrow Neurological Institute / Barrow Brain & Spine (Phoenix)
Neurological Institute+2 • Barrow Brain & Spine Patient Navigator: (602) 406-8450 Barrow Brain and Spine • Barrow Second Opinion / Transfer: call (602) 406-3396 Barrow Neurological Institute+1 • Neurosurgery Department Contact: (480) 301-8000 Mayo Clinic • Referrals Phone: 866- 629-6362 toll-free or 480-301-7085 locally Mayo Clinic • Referring Physician / Provider Relations: Mayo Clinic CareLink portal; Fax as needed. Mayo Clinic+2Mayo Clinic+2
Mayo Clinic Phoenix / Scottsdale
Tailored Email Template (for Barrow & Mayo Phoenix)
Subject: Request for LITT Evaluation — Hypothalamic/Mammillary Area Lesion Hello Dr. [Last Name] / Neurosurgery Team, My name is [Your Name], and I am seeking a specialist evaluation for Amy [Last Name] , age [XX]. Her most recent MRI shows a cyst/lesion compressing the mammillary bodies / hypothalamic area . We would like to request an evaluation to determine if MRI-guided Laser Interstitial Thermal Therapy (LITT) may be a safe and appropriate treatment option in her case. Key background: • Imaging: MRI brain with/without contrast (thin-slice protocol), latest study dated [MM/DD/YYYY] • Location/size of lesion (as per radiology): approximately [X mm] in [specific area] adjacent to mammillary bodies / hypothalamus • Symptoms: [list: e.g. memory problems, endocrine disturbance / hormonal labs, sleep disturbance, etc.] • Prior assessments: Neurology, endocrinology workup, lab results if available • Current medications and allergies: [list] What we are hoping for: 1. A review of her imaging and medical records (MRI / CD / DICOM including reports) to assess LITT feasibility, including planning for trajectory and safety relative to nearby sensitive structures (fornix, mammillothalamic tract, optic tracts).
2. If feasible, to schedule a consult (in person or via telehealth) with a neurosurgeon experienced in hypothalamic / mammillary / deep midline LITT cases. 3. Information on where & how to send imaging and records (secure upload portal, patient/referring physician record transfer) ahead of the consult.
Attachments / To be provided: • MRI scans / DICOMs + radiology report(s) • Prior MRIs for comparison • Relevant clinical notes / endocrine labs
We are based in Arizona and willing to travel. Please let us know the best next steps, any required referral/authorization forms, and earliest available consultation times. Thank you very much for your time and expertise. Sincerely, [Your Name]
Phone: [Your Phone] Email: [Your Email]
Phone Script (for Barrow & Mayo) Use this when calling the referral or neurosurgery clinic.
Hi, my name is [Your Name]. I’m calling about arranging a consultation for a patient named Amy [Last Name] who has a cyst/lesion pressing on the mammillary region / hypothalamus. We want to explore whether Laser Interstitial Thermal Therapy (LITT) is possible. What I’m hoping to do is: • find out how to send imaging (MRI / DICOMs) and medical record
summaries in advance; • confirm whether you have a neurosurgeon who does LITT for deep/midline lesions; • schedule a consult (in person or telehealth) Could you please connect me to the team that handles new neurosurgery referrals / LITT work? And could you tell me the best way to get records over securely?
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