“Remain calm, because peace equals power.” – Joyce Meyer 

PNA Spotlight: Dr. Maria Peris Celda

This month the PNA Spotlight focuses on Dr. Maria Peris Celda, a Professor in Neurosurgery, Otolaryngology, and Surgical Anatomy at Mayo Clinic in Rochester, Minnesota.  Dr. Peris Celda earned a PhD in neurosciences and her MD from the University of Valencia in Spain.  She has done a fellowship in Microsurgical Endoscopic Anatomy at the University of Florida in Gainesville; and a Neurosurgical Skull Base Oncology fellowship at Mayo Clinic in Rochester, Minnesota. She also completed two residencies in neurological surgery: at the University of Valencia in Spain, and at Albany Medical Center in New York. She was kind enough to answer some questions from the PNA. Her answers follow.

Please tell us about your background.

I was born in Valencia, Spain and earned my undergraduate degree, PhD, and my medical degree there. I specialize in skull base surgery, and a great part of my practice includes treatment of pituitary adenomas.

Why did you choose pituitary medicine?

Treatment of these complex lesions (found around very delicate structures) is really challenging. It requires focus, care and attention. It’s extraordinary because each case is unique. I really enjoy performing surgeries that give the patient the best, safest standard of care.

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Navigating Complex Pituitary Surgery Safely, Dr. Maria Peris Celda

Pituitary tumors often sit in one of the most delicate areas of the brain. While many can be treated safely and effectively, some grow into nearby spaces that make surgery more complex.

According to Mayo Clinic neurosurgeon Maria Peris Celda, MD, PhD one of the most challenging areas to operate is the cavernous sinus, a narrow corridor close to the pituitary gland. This anatomically complex region contains critical arteries and nerves responsible for eye movement and blood flow to the brain, which means even minor injuries can have profound consequences.

For years, tumors involving this area were often considered too risky to remove surgically. But advances in endoscopic surgery, performed through the nose without external incisions, have changed what’s possible. Despite this, success depends on a surgeon’s deep understanding of the anatomy hidden just millimeters from the pituitary gland.

That is the focus of Dr. Peris Celda’s recent research, which intricately maps the tiny blood vessels branching off the internal carotid artery as they pass through the cavernous sinus. These vessels are not usually visible on imaging but play a critical role in supplying blood to the nerves that control eye movement and sensation.

Using detailed anatomical specimen dissections performed from the same endoscopic viewpoint used in modern surgery, Dr. Peris Celda and her colleagues identified consistent landmarks that help surgeons navigate this area more safely.

In the past, surgeons had to open the skull and retract the brain to study and reach this region. Today, advanced endoscopic techniques allow surgeons to access the same anatomy through the nasal passages, offering a direct view without external incisions. Their work shows which blood vessels and branches of the internal carotid artery are present in every person, where they are located in relation to the pituitary gland, and which nerves they support.

Dr. Peris Celda notes that knowledge of these blood vessels and its variations help in avoiding injury to one of the main arteries that supply blood flow to the brain, the carotid artery.  She also explains that nerve injuries do not always occur from direct damage to the nerve itself. In some cases, problems arise when blood flow to the nerve is disrupted.  Understanding the location of these small vessels helps surgeons reduce that risk.

For pituitary tumor patients, this research translates directly into safer care. By understanding these anatomical details, surgeons can remove more tumor tissue while reducing the risk of complications such as carotid artery injury, double vision, eye movement problems, or stroke. It also allows experienced teams to operate in areas that were once avoided altogether.

At Mayo Clinic in Rochester, Minnesota, pituitary surgery is performed by a specialized team that includes neurosurgeons, ear, nose and throat surgeons, endocrinologists, and ophthalmologists. This multidisciplinary approach ensures that each patient’s tumor, hormone function, and vision are carefully evaluated before and after surgery.

For patients facing complex pituitary tumors, this exceptional expertise can make all the difference, offering safer surgery, better outcomes, and greater peace of mind.

For more information or to request an appointment, please visit Pituitary Tumors – Mayo Clinic.

PNA Medical Corner: X-Linked Acrogigantism

This month the PNA Medical Corner focuses on a study coauthored by longtime PNA member Albert Beckers. It looks at a severe form of pituitary gigantism called X-LAG.

Ann Endocrinol (Paris)

. 2026 Mar 24:102511.

 doi: 10.1016/j.ando.2026.102511. Online ahead of print.

Genome architecture in endocrine diseases: X-Linked Acrogigantism (X-LAG) syndrome

Adrian F Daly ¹, Albert Beckers ², Patrick Pétrossians ²

Affiliations Expand

• PMID: 41887597   DOI: 10.1016/j.ando.2026.102511

Abstract

X-linked acrogigantism (X-LAG) is a rare disease that represents a severe form of pituitary gigantism characterized by early-onset growth hormone (GH), insulin-like growth factor 1 (IGF1) and prolactin excess. X-LAG is associated with duplications involving the gene GPR101 on chromosome Xq26.3. Clinically, X-LAG manifests in infancy, with a median age at onset of 18 months, presenting as rapid linear growth, acral enlargement, and large pituitary macroadenomas. While predominantly a sporadic disease affecting females through constitutional duplications, somatic mosaicism is found in sporadic male cases. Three familial cases of X-LAG have been described. Management is difficult due to the young age of affected patients and the relative resistance of GH excess to somatostatin analogs. Multimodal therapy, including neurosurgery and medical therapy such as pegvisomant, is often required to achieve hormonal control and limit final adult height. Unlike other genetic forms of pituitary tumorigenesis that are due to sequence-based mutations, X-LAG is caused by structural changes in 3D genome architecture. Specifically, microduplications on chromosome Xq26.3 disrupt a topologically associating domain (TAD) containing GPR101. This process facilitates the formation of a “neoTAD,” where the GPR101 promoter is driven by ectopic enhancers, primarily an intronic enhancer located within the VGLL1 gene, leading to massive pituitary upregulation of this constitutively active receptor and GH excess. X-LAG is an example of how novel disease mechanisms can explain the molecular dysregulation behind rare and difficult to manage endocrine pathologies.

Keywords: GPR101; TAD; X chromosome; X-linked acrogigantism; acromegaly; gigantism; topologically associated domain.

Copyright © 2026 Elsevier Masson SAS. All rights reserved.

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