Dr. Kevin Lillehei is chair of the Department of Neurosurgery at the University of Colorado School of Medicine in Aurora, Colorado. He started there in 1985 and his primary work is with benign and malignant brain tumors. He is also codirector of their Pituitary Center of Excellence, and director of the neurosurgery oncology fellowship. He did his undergraduate work at Cornell University in New York, where he double majored in physics and chemistry. He then went to medical school at the University of Minnesota and did his residency at the University of Michigan in Ann Arbor, where he really became interested in pituitary tumors. His mentor was Dr. William Chandler, who, at the time, did virtually all of the pituitary tumors at the University of Michigan. When Dr. Lillihei left Michigan, he spent two years at the University of Colorado’s trauma hospital, which at the time was called Denver General Hospital. After two years there, he transferred over to the University Hospital. He was kind enough to answer a series of questions from the PNA about his career.
What inspired you to choose your career path?
At the University of Colorado, they really needed somebody to take over the pituitary tumor surgery part. And I was lucky enough to been at Colorado at the same time as an endocrinologist by the name of Dr. E. Chester Ridgway. And Dr. Ridgway had just come to the University of Colorado from Mass General and the two of us really joined forces and established the pituitary surgery at that time around 1987. In our pituitary program we do about 140 cases a year, and have a very large network of other interdisciplinary departments that we all work with.
What message would you like to convey to your patients?
The treatment of pituitary tumors in each individual is unique, but the approach really has to be multi-disciplinary to get the best care. And I think that’s critically important that you’ve got a team, you know, of endocrinologists, of neurosurgeons, of neuropathologists, of neuro ophthalmology, working together on these patients. And we’ve been able to do that, very well. We hold a clinic together with endocrine that sees these patients. We have a monthly pituitary conference, which is both educational and involves clinical decision-making. So everybody’s very deeply involved. We’ve got a neuropathologist by the name of Dr. Betty Kleinschmidt-DeMasters, who is probably one of the top pituitary pathologists in the country. We’re just we’re also getting our psychology psychiatry department involved in the care of these patients. Obviously, as you know, patients with both Cushing’s disease and acromegaly for that matter, have a lot of emotional difficulties. So I think that is an important part.
How did you get involved with the PNA?
Mr. Robert Knutzen and I first met, probably in the 1990s, so, so quite a while ago, when I became involved in the group, back when it was called the PTNA – Pituitary Tumor Network Association. The PNA gets good medical information on the internet and social media, which can often very difficult to find. I respect the PNA because I think it’s been very good source of information for patients. It’s reliable. It’s well done. And they also offer support, which I think is terrific. So I think it’s a very credible organization that is a real benefit to patients. Treatment of patients with pituitary region tumors has been a large part of my practice for over 35 years. During this time, I have strived to always offer the best care possible, whether surgical, medical or a combination of both. Over the years, I have worked closely with the PNA and know firsthand that this is their goal as well. With like-minded visions, I am honored to be a member of PNA’s Medical Advisory Board and to work towards this common goal.
What would you like people to know about the primary focus of your work, or research?
At the university there’s two people on the endocrine side who really do the bulk of the primary research. We’ve been able to maintain a tissue bank of pituitary tumors, which is now probably about 1000 specimens. We try to save a piece of tissue from our cases and store them in the tissue bank for research purposes. And our research has been focused a lot around acromegaly, growth hormone-secreting tumors, the difference between densely granulated and sparsely granulated, and their response to therapy, which is significantly different between the two. And then also looking at corticotrope adenomas and trying to kind of decide what factors influence their recurrence rate and their invasiveness. In malignant tumors of the brain, our clinical and research work has centered on novel uses of immunotherapy for treatment of high-grade gliomas. In addition, we are invested in improving the extent of resection of these tumors, with minimizing morbidity. For pituitary tumors, we have had a particular clinical and research interest in patients with acromegaly and Cushing’s disease. This is a group of patients, in particular, require a multi-disciplinary team approach to treatment, and we are fortunate to have assembled such a team in Colorado. Currently I have personally done over 3,000 transsphenoidal procedures, working closely with our endocrinology associates.
What would you consider to be the future of the field?
I’m a surgeon, and we’ve transitioned a little bit on the surgery side, going more from microscopic to endoscopic, but I think that the future is really the ability to treat these tumors like we do prolactinomas with medical management that would be amazing. The medications that we have available for us to treat both growth hormone and ACTH-secreting tumors has gotten better and better. No question about it. The future of our field also lies in being able to recognize these lesions earlier
and provide treatment before the development of neurologic and/or endocrinologic
dysfunction.
What should patients know more about? What deserves more awareness?
It’s critically important to have a multi-disciplinary team. I see over and over again where, sure, you can go to a surgeon and they can operate on a pituitary tumor, but there’s the follow up and the multidisciplinary team, I don’t think you get the best care or the best outcome. So I think that’s probably the most critically important factor. The other is, speaking as a surgeon, I think you’re certainly best off going to a center where the surgeons have an experience with pituitary tumors. I think there was a recent study from about four or five years ago that a majority of pituitary tumors are done by neurosurgeons who do maybe less than 10 a year. And I think that’s probably not the best case scenario.
What would you like to convey about yourself to your patients?
Treatment of pituitary tumors is unique to each individual and I approach each patient in this manner. Treatment of these lesions has been a life-long passion of mine and we always strive to do the best job we can for each individual.