Sufficient sleep, exercise, healthy food, friendship, and peace of mind are necessities, not luxuries.” – Mark

PNA Spotlight: Dr. Jonathan Breshears

This month the PNA Spotlight focuses on Dr. Jonathan Breshears, a neurosurgeon at St. Luke’s Hospital in Kansas City, Missouri and a Clinical Assistant Professor in the Department of Surgery at the University of  Missouri-Kansas City School of Medicine.  Dr. Breshears did his undergraduate work and earned his M.D. at Washington University in St. Louis. He did a residency at UCSF Medical center and a fellowship in open and endoscopic skull base surgery at MD Anderson Cancer Center.  He specializes in the treatment of benign and malignant tumors involving the brain and skull base, particularly pituitary tumors, acoustic neuromas, and meningiomas. He was kind enough to answer a series of questions from the PNA. Here are his answers, lightly edited for clarity.

Please tell us a little bit about your practice

I did my neurosurgery training at UCSF, and there I had the good fortune to be exposed to some really excellent pituitary surgeons including Sandeep Kunwar, Manish Aghi, and also Louis Blevins. They are my early mentors in pituitary surgery, and how I got exposure to the PNA. From there, I did a skull base fellowship at MD Anderson and had more specialized training in taking care of lesions on the base of the skull, and pituitary tumors as a part of that.  My practice now is in Kansas City, Missouri, at the St Luke’s Hospital at the Marion Bloch Neuroscience Institute. I’ve been here five years, and we’ve built up a multi-disciplinary team, including endocrinologists, neuropathologists, neuroradiologists, a neuro ophthalmologist as well as my anterior skull base partner, Dr. Vidur Bhalla, who’s a rhinologist trained in skull based surgery.  We have a multi-disciplinary program to help take care of patients with pituitary tumors, because those tumors require a team of highly trained specialists. We have all those people in place, part of a specialized program to help take care of these patients.  We also have a nurse navigator for our program, so when we get referrals or when people call in, especially if there’s an acute symptom like vision loss, we really try to expedite their care. This way they are able to see multiple specialists and get the labs and the imaging they need as a part of the workup, all in the same day. This minimizes the number of trips the patient has to make.

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How a Mayo Clinic-Led Imaging Breakthrough Is Transforming Pituitary Tumor Diagnosis and Treatment

 For patients dealing with pituitary tumors, an accurate diagnosis is the first step toward effective treatment. But in many cases—especially with rare conditions like Cushing’s disease—the tumors can be so small that standard imaging protocols struggle to detect them. Now, thanks to a cutting-edge technology called Photon Counting Detector CT, doctors are seeing these elusive tumors with greater clarity than ever before.

Pioneered in collaboration with Mayo Clinic physicians and researchers, Photon Counting Detector CT showed promising results in a recent Mayo-led study.

Pituitary tumors, particularly those responsible for Cushing’s disease, can be extremely small—sometimes only a few millimeters in size. While traditional MRI is the standard imaging protocol for these tumors, it sometimes doesn’t provide enough detail to precisely locate them. In fact, MRI has historically failed to detect pituitary tumors in nearly 50% of Cushing’s cases. This can leave patients facing additional testing or even exploratory surgery, which can be risky and invasive given the pituitary gland’s small size and delicate nature. Current MRI technology may not get high enough spatial resolution to capture these small tumors of 2mm to 3 mm, and higher field strength MRI scanners have challenges with imaging distortions at the skull base where these tumors are found. 

“Cushing’s tumors are among the hardest to find because they’re so tiny and blend in with normal pituitary tissue,” explains Mayo radiologist Dr. Ian Mark. “With Photon-Counting Detector CT, we’re seeing details we simply couldn’t see before. It allows us to locate tumors that are hard to detect on MRI. This means patients can have a more targeted surgery with a better chance of success.”

Mayo neurosurgeon Dr. Jamie Van Gompel adds, “If I know where the tumor is and I can confidently go get it, I’m going to have an 80% rate of cure as opposed to 50% with exploration.”

For patients, the benefits of Photon Counting Detector CT are compelling. Earlier and more accurate diagnosis reduces the need for additional testing. The enhanced imaging it enables gives neurosurgeons a better-informed preoperative plan, which can reduce the need for exploratory procedures and lead to better outcomes.

“It’s a true game changer for patients with Cushing’s disease and other complex pituitary conditions,” says Dr. Van Gompel. “By improving our ability to see these tumors before surgery, we’re improving the likelihood of curing the disease with the least amount of intervention,” adds Dr. Mark.

For Drs. Mark and Van Gompel, the technology is emblematic of Mayo Clinic’s multidisciplinary approach to patient care. “Things like this only occur at places where you have lots of people from different disciplines sitting down, talking about problems, and looking for new ways that we can help our patients. I think that’s one of the things we do best here,” says Dr. Van Gompel.

The rarity of Cushing’s disease makes it challenging to study, but future research with larger patient groups is planned. While it’s still a relatively new technology in pituitary tumor diagnosis, its long-term potential as a complement to MRI is clear. As it becomes more widely adopted, it could become a key tool in advancing the treatment of complex pituitary diseases, helping more patients get the care they need—faster and with greater precision.

Developed in collaboration with Mayo Clinic’s team of multidisciplinary experts, Photon Counting Detector CT is readily available at Mayo Clinic. If you’re facing a pituitary tumor diagnosis, contact a Mayo Clinic specialist to learn more about your imaging and treatment options.

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

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)