“If you achieve all kinds of things in the material world, but you lose your health or your peace of mind, you get little or no pleasure from your other accomplishments.” – Brian Tracy

PNA Spotlight: Dr. Gelarah Zadeh

This month the PNA Spotlight focuses on Gelarah Zadeh, M.D., Ph.D., a neurosurgeon at Mayo Clinic in Rochester, Minnesota.   She specializes in gliomas and meningiomas. She earned her bachelor’s degree and her M.D. at the University of Manitoba.  She did her postdoctoral training and then a Ph.D. at the University of Toronto.  She completed fellowships at the University Health Network, at University College of London, and at the Canadian Institutes of Health. We posed some written questions to Dr. Zadeh; her answers are below.

What inspired you to choose this career path?

I had outstanding mentors, including Dr. Norman Hill who was a neurosurgeon in Manitoba and had trained at Mayo Clinic. I also want to recognize my neuroanatomy instructor, retired neurosurgeon Dr. Dwight Parkinson, who also trained at Mayo Clinic and was the first neurosurgeon in Canada. Drs. West and Fewer allowed me to experience neurosurgery in the operating room and see the intricate procedures, sparking my interest in the field. Dr. Fewer oversaw my first pituitary surgery.

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Caring for Pituitary Tumors: It Takes a Village of Experts

A pituitary tumor diagnosis can leave you with more questions than answers. You might wonder why you’re feeling the way you do, whether it’s serious, and what happens next. What makes it more confusing is how different each case can be.

Though typically noncancerous, these tumors can affect critical functions the pituitary gland controls. Symptoms can range from subtle to disruptive, and the right treatment path isn’t always obvious.

The pituitary gland itself is small and delicately situated at the base of the brain—close to the optic chiasm and the carotid arteries. Tumors in this area can grow enough to press on nearby structures, impacting hormone levels, vision, energy, and more. Even small changes in this part of the brain can have wide-ranging effects on the body.

Because of this complexity, treating pituitary adenomas effectively requires a coordinated team of multidisciplinary experts working toward a single goal: doing what’s best for the patient. It’s a model of care that’s increasingly seen as essential—and at major centers like Mayo Clinic, it’s already the standard.

“Pituitary tumors don’t exist in a vacuum,” said Mayo Clinic neuro-oncologist Dr. Maciej M. Mrugala. “They can affect multiple systems in the body, and it usually takes input from several different specialties to understand the full picture.”

That team may include an endocrinologist to assess hormone function, a neurosurgeon to evaluate surgical options, an ophthalmologist to monitor vision changes, and a radiologist to interpret imaging. In some cases, a radiation oncologist or pathologist may also be involved. Rather than moving from specialist to specialist in isolation, some providers bring all of these perspectives together through a multidisciplinary team. This approach can make a significant difference—not only in how decisions are made, but also in how quickly patients get answers.

At Mayo Clinic, pituitary cases are reviewed each week by a dedicated team of specialists. According to Dr. Mrugala, these case conferences allow for a deep dive into each patient’s imaging, lab results, history, and symptoms, with real-time input from everyone involved in the case. “This is not just a formality,” he said. “It’s a working meeting where we discuss what we’re seeing, what it might mean, and how best to move forward. It often informs or improves the treatment plan.”

For patients, this means their case doesn’t rely on a single physician’s perspective. Instead, they benefit from a collaborative review by experts who regularly treat pituitary tumors—and who understand that no two cases are alike.

Pituitary tumors can behave very differently depending on their type, size, location, and whether they produce hormones. Some are best managed with medication. Others require surgery. In certain cases, watchful monitoring may be the safest choice.

“There’s no standard algorithm that fits everyone,” Mrugala noted. “It’s really about matching the treatment to the individual—what symptoms they’re having, how the tumor is behaving, and what’s going on in their life.”

He noted that having multiple disciplines at the table helps ensure the care plan reflects the full scope of the patient’s needs.

For someone newly diagnosed with a pituitary tumor, navigating the medical system can be as overwhelming as understanding the tumor itself. A team-based approach offers more than medical insight—it provides clarity, direction, and the assurance that the full picture is being seen.

Dr. Mrugala sees that as central to good care. “Patients don’t just want the right answer,” he said. “They want to know that someone is thinking it through, looking at every angle, and making decisions with their best interest in mind. That’s what the team is there to do.”

For more information or to request an appointment, please visit Pituitary Tumor Care – Mayo Clinic    

Surgical and non-surgical approaches to pituitary tumor care

For people with a pituitary tumor diagnosis, determining whether surgery is needed depends on the size and characteristics of the tumor. Pituitary adenomas are usually benign and slow growing, but they’re not always harmless. Some tumors grow in ways that disrupt your body’s hormone production. Others can grow large enough to compress nearby structures, including the optic nerves — which are responsible for your vision.

The pituitary gland, an extremely delicate, pea-sized gland located at the base of the brain, controls the body’s hormonal systems. “It’s basically the conductor of a very complex orchestra of hormones that regulate many of your body’s functions,” says Mayo Clinic Neurosurgeon Dr. Maria Peris-Celda.

Tumors that grow from this gland usually fall into two main categories: those that produce hormones (called functioning tumors), and those that do not (non-functioning tumors).

“When a tumor is producing hormones in excess — like prolactin, cortisol, or growth hormone — the first step is to try to control or cure the disease,” says Dr. Peris-Celda. “If it’s a prolactinoma, we often can treat it with medication. But for others, like tumors that cause Cushing’s disease or acromegaly, surgery is usually the first and best option.”

On the other hand, nonfunctioning tumors often grow silently — without symptoms — because they’re not producing extra hormones. But as they grow larger, they can press against nearby structures. One of the most concerning complications is pressure on the optic nerves, which can cause progressive vision loss.

“The optic nerves from each eye come together at the base of the brain, forming what’s called the optic chiasm — and that area is only a few millimeters from the pituitary gland,” explains Dr. Peris-Celda. “Tumor growth can compress that area, resulting in vision loss that starts with the peripheral vision — then slowly progresses toward the center.”

Figure 1 & 2. How a Pituitary Tumor Can Affect Nearby Structures

Figure 3. A typical example of endoscopic transnasal transsphenoidal surgery

Unfortunately, because this type of vision loss happens gradually, many people don’t notice it until it’s significant. That’s why Dr. Peris-Celda recommends routine vision exams for people with pituitary tumors. “A visual field test can catch early changes, and an MRI can show if the tumor is approaching the optic nerves even before vision is affected.”

If a tumor shows progressive growth, is pressing on the optic apparatus— or causing other symptoms that can’t be controlled with medication — surgery becomes necessary. Most surgeries are performed through the nose using an endoscope, a minimally invasive approach that doesn’t require any external incisions. Surgery often leads to significant improvement or resolution, even in cases involving large tumors or patients who have experienced vision loss. In many instances, at least some of that vision can be restored.

At Mayo Clinic, these procedures are performed by a dedicated team of neurosurgeons and ear, nose, and throat (ENT) surgeons, in collaboration with endocrinologists.

According to Dr. Peris-Celda, experience matters when it comes to treating pituitary challenges. “You want a skilled surgeon who specializes in treating these kinds of tumors routinely — not just occasionally,” she said, adding, “It’s a very delicate area, close to the optic nerves and carotid arteries. Our team performs hundreds of these surgeries each year, so our experience and expertise gives patients a great chance for a safe procedure and an excellent outcome.”

Most patients go home the day after surgery and are followed closely on an outpatient basis. “We monitor recovery and hormone levels carefully to make sure patients heal well and stay healthy,” she adds.

The bottom line: Not all pituitary tumors require surgery, but if your tumor is affecting your vision, shows progressive growth or can’t be managed with medication, it may be the best — and safest — treatment path.

For more information or to request an appointment, please visit Pituitary Tumor Care – Mayo Clinic

PNA Medical Corner: Prolactinomas

This month the PNA Medical Corner features a review study coauthored by two longtime members of the PNA: Professor Maria Fleseriu MD and Professor Shlomo Melmed MD.  The authors reviewed the literature on the pathogenesis, diagnosis and management of prolactin-secreting adenomas.

Dr. Maria Fleseriu

Dr. Shlomo Melmed

Summary

Hyperprolactinaemia can result from physiological causes, pharmacological agents, or pathological conditions such as prolactin-secreting pituitary adenomas and other pituitary stalk-compressing masses. Sporadic prolactinomas are the most common functioning pituitary adenomas, with a female predominance during reproductive years. In men, these adenomas are usually larger and more aggressive. Prolactinomas are characterised by positive immunostaining for prolactin, pituitary-specific positive transcription factor 1, and oestrogen receptor α. Dopamine agonists, particularly cabergoline, are typically used as primary therapy. Treatment with up to 2·0 mg per week of cabergoline for at least 6 months normalises prolactin concentrations, achieves adenoma shrinkage of at least 30%, and restores gonadal function in most patients. Transsphenoidal surgery is increasingly used as primary therapy for small prolactinomas given a high chance of remission; transsphenoidal surgery is also indicated for patients with dopamine agonist intolerance or resistance. Radiotherapy is reserved for treatment-refractory prolactinomas. Multidisciplinary management and an individualised approach are key to maximising therapeutic responsiveness and optimising outcomes. In this Review, we assess evidence relating to pathogenesis, diagnosis, and management of prolactinomas, and highlight opportunities for future research.

Introduction

Prolactin-secreting lactotroph pituitary adenomas, also known as prolactinomas, account for more than half of all pituitary adenomas.¹ Hyperprolactinaemia due to causes other than a prolactinoma is increasingly being recognised. An accurate differential diagnosis is paramount. Most frequently, prolactinomas are diagnosed as microadenomas of less than 10 mm in maximal diameter, in combination with elevated prolactin concentrations. Dopamine agonists are typically used as primary therapy,² although patient preference and opportunity for cure have led to increased use of transsphenoidal surgery for small microadenomas, especially in specialised centres.3, 4, 5 Giant (≥40 mm) and cystic prolactinomas might need distinctive consideration for both diagnosis and treatment.⁶ More aggressive or treatment-resistant prolactinomas might require multimodal medical, surgical, and radiation therapy.⁷ Dr. Maria Fleseriu

This Review is relevant for a wide range of clinicians who might encounter patients with hyperprolactinaemia and prolactinomas, including: primary care practitioners, internists, endocrinologists, neurosurgeons, reproductive medicine and gynaecology specialists (given the effects of oestrogen on lactotrophs), psychiatrists (given the effects of antipsychotics on prolactin and the potential for psychiatric side-effects of cabergoline), and neuro-oncologists for aggressive prolactinomas.

Here, we review management of adults with prolactinomas. Management of children and adolescents with prolactinomas is largely similar, but clinical features unique to these populations can drive specific diagnostic workup and treatment decisions.8, 9, 10, 11 Recently published guidelines 12, 13 on management of pituitary adenomas in children and adolescents highlight the need for optimal multidisciplinary care.

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