“Health is a state of complete harmony of the body, mind, and spirit.”

— B.K.S. Iyengar

PNA Spotlight: Dr. Adam Mamelak

This month the PNA Spotlight focuses on Dr. Adam Mamelak, a neurosurgeon and co-director of the Pituitary Center at Cedars Sinai Medical Center in Los Angeles. Dr. Mamelak earned his B.A. in Physics at Tufts University and earned his MD from Harvard Medical School. He did a surgical internship and then a residency at the University of California at San Francisco Medical Center. He did a fellowship at the Epilepsy Research Laboratory at UCSF, and another postdoctoral fellowship in neuroscience at the California Institute of Technology & Huntington Medical Research Institutes in Pasadena, California. Dr. Mamelak was kind enough to answer a series of questions from the PNA.

His answers are below:

PNA Medical Corner: New options for imaging MRI-resistant Cushing tumors

The tiny tumors that cause Cushing disease are tough to detect with standard MRI. Fortunately, some new options are available, boosting the chances for successful treatment.

“Sometimes pituitary tumors are so small, they’re nearly impossible to see,” says Mayo Clinic neurosurgeon Dr. Jamie J. Van Gompel. “The success of surgery drops dramatically when we can’t see these tumors on imaging. Anything that tells us where the tumor is will help us determine the risks of surgery and also improve the chances of long-term cure.”

About half the tumors that cause Cushing disease aren’t clearly visible on standard MRI. Standard MRI provides 2D images of relatively large sections of the pituitary, which might not show a tumor that’s only several millimeters in size. Pituitary MRI is also prone to visual flaws or artifacts.

“It’s hard for MRI to image tissue that’s near air. And the pituitary always has air next to it, from the sinuses,” explains Mayo Clinic neuroradiologist Dr. Ian T. Mark.

    Featured News and Updates

    News Articles October 2024

    New acromegaly drug on the horizon

    A new drug for treatment and long-term maintenance therapy for acromegaly is now on the horizon. Crinetics Pharmaceuticals recently submitted its first new drug application (NDA) to the U.S. Food and Drug Administration for paltusotine, which is a once-daily oral selectively-targeted somatostatin receptor type 2 nonpeptide agonist.

    Crinetics says researchers used data from from 18 clinical trials in the application, including two Phase 3 trials that evaluated paltusotine for acromegaly in medically untreated and treated patients.   Patients tolerated the treatment well, the medication achieved biochemical control by maintaining IGF-1 levels and improved patients’ symptoms compared to placebo.   The company says it expects to hear back from the FDA by December.

    Paltusotine, is the first drug of its type to complete Phase 3 clinical development for acromegaly and is now in Phase 2 clinical development for carcinoid syndrome associated with neuroendocrine tumors.  Read the company’s press release here. 

     

    Can machine learning to predict hormone deficiency after pituitary surgery?

    A study featured on Nature.com used machine learning algorithms to predict whether patients would develop arginine vasopressin deficiency after transsphenoidal surgery to remove a pituitary adenoma. Read more here: https://www.nature.com/articles/s41598-024-72486-w

     

    Pituitary apoplexy strikes groom on wedding day

    An article in People.com tells the story of a groom in England who had to leave his wedding reception early due to a severe headache – one that turned out to be a hemorrhaging pituitary tumor. Read more here: https://people.com/groom-migraine-wedding-day-tumor-popped-8718083

     

    Researchers try to make synthetic oxytocin for pain relief

    An article in the Focus.news looks at efforts to replicate the hormone oxytocin in the lab – in an effort to develop a painkiller that would be safer than opioids. Read more here: https://www.thefocus.news/lifestyle/scientists-are-hoping-to-replicate-the-cuddle-hormone-for-healthy-long-term-pain-relief/

    Research Articles

    October 2024 Research Articles

    Pituitary Tumors

    Investigating the relationship between cognitive impairment and brain white matter tracts using diffusion tensor imaging in patients with prolactinoma.

    Duru M, Demir AN, Oz A, Kargin OA, Altunc AT, Demirel O, Arslan S, Kizilkilic O, Poyraz BC, Kadioglu P.J Endocrinol Invest. 2024 Oct 3. doi: 10.1007/s40618-024-02442-y. Online ahead of print.

     

    Androgen Receptor Mediates Dopamine Agonist Resistance by Regulating Intracellular reactive oxygen species (ROS) in Prolactin-secreting Pituitary Adenoma.

    Xu L, Lei Z, Wang Q, Jiang Q, Xing B, Li X, Guo X, Wang Z, Li S, Huang Y, Lei T.Antioxid Redox Signal. 2024 Oct 3. doi: 10.1089/ars.2024.0611. Online ahead of print.

     

    Beyond Epistaxis: A Rare Case of Ectopic Sinonasal Adamantinomatous Craniopharyngioma.

    Selva Kumaran K, Shamsudin NS, Dalip Singh HS, Devesahayam PR.Cureus. 2024 Sep 1;16(9):e68357. doi: 10.7759/cureus.68357. eCollection 2024 Sep.


    Posterior pituitary tumors and other rare entities involving the pituitary gland.

    Roncaroli F, Giannini C.Brain Pathol. 2024 Sep 30:e13307. doi: 10.1111/bpa.13307. Online ahead of print.PMID: 39350562 Review.

     

    Pituitary Apoplexy in Pregnancy: Neonatal Implications.

    Megan Y, Melissa S.Neoreviews. 2024 Oct 1;25(10):e660-e663. doi: 10.1542/neo.25-10-e660.

     

    Giant pituitary macroadenoma with apoplexy presenting with isolated bilateral hypoglossal nerve palsy: illustrative case.

    Zaher M, Kolmetzky DW, Al-Atrache Z, Vimawala S, Kolia NR, Godil SS.J Neurosurg Case Lessons. 2024 Sep 30;8(14):CASE24326. doi: 10.3171/CASE24326. Print 2024 Sep 30.

     

    Typical Morphological Characteristics of the Immunohistochemistrical Subtypes of Pituitary Microadenomas: A dual center study.

    Zhang L, Yan S, Xie SK, Wei YT, Liu HP, Li Y, Wu HB, Wang HL, Xu PF.Endocr Connect. 2024 Sep 1:EC-24-0378. doi: 10.1530/EC-24-0378. Online ahead of print.

     

     

    Acromegaly

     

    Efficacy and safety of pasireotide treatment in acromegaly: A systematic review and single arm meta-analysis.

    Aliyeva T, Muniz J, Soares GM, Firdausa S, Mirza L.Pituitary. 2024 Oct 1. doi: 10.1007/s11102-024-01461-5. Online ahead of print.

     

    Cushing’s

     

    Frequency of clinical signs in patients with Cushing’s syndrome and mild autonomous cortisol secretion (MACS): Overlap is common.

    Braun LT, Vogel F, Nowak E, Rubinstein G, Zopp S, Ritzel K, Beuschlein F, Reincke M.Eur J Endocrinol. 2024 Oct 1:lvae127. doi: 10.1093/ejendo/lvae127. Online ahead of print.

     

     

    Pituitary Surgery

     

    Stereotactic radiosurgery for recurrent/residual nonfunctioning pituitary adenoma: a single-arm systematic review and meta-analysis.

    De Nigris Vasconcellos F, Vilela MAD, Torrico FG, Scalise MA, Vargas VPS, Mendieta CD, Pichardo-Rojas P, Rosi MEA, Fleury LT, de Brito Rebelo ND, Benjamin C, Sheehan JP.Acta Neurochir (Wien). 2024 Oct 2;166(1):392. doi: 10.1007/s00701-024-06296-4.PMID: 39356336 Review.

    Editor’s note: Dr. Sheehan is a member of the PNA.

     

    Hormonal Health


    Prolactin deficiency in the context of other pituitary hormone abnormalities : Special issue: hypoprolactinemia: a neglected endocrine disorder.

    Shimon I.Rev Endocr Metab Disord. 2024 Oct 2. doi: 10.1007/s11154-024-09902-z. Online ahead of print.PMID: 39356415 Review.

     

    The Ser434Phe Androgen Receptor Gene Mutation Does Not Affect Fertility but is Associated with Increased Prolactin.

    Saadeh NA, Obeidat M, Shboul M.Appl Clin Genet. 2024 Sep 26;17:143-149. doi: 10.2147/TACG.S466919. eCollection 2024.

     

    The FDA has approved NGENLA (somatrogon-ghla)

    The FDA has approved NGENLA (somatrogon-ghla), a once-weekly, human growth hormone analog indicated for treatment of pediatric patients aged three years and older who have growth failure due to an inadequate secretion of endogenous growth hormone.

    See the Press Release here>

    Count on your Xeris CareConnection™ Team for unparalleled Cushing’s Support

    Cushing’s can be challenging, but there is support so patients can feel like themselves again. The main goal of treating Cushing’s is to get cortisol levels back to normal. This Pituitary Awareness Month, Xeris Pharmaceuticals® is highlighting the importance of one-on-one support for patients living with Cushing’s Syndrome and support for HCPs treating Cushing’s Syndrome.

    Sign up to get dedicated support:

    Patients: Sign up for support | Recorlev® (levoketoconazole)

    HCP’s: Connect with Xeris support | RECORLEV® (levoketoconazole)

    Have more questions? Call for more support at 1-844-444-RCLV (7258)

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