“Take a few minutes each and every day to ensure that your mind is nourished properly and positively. After all, a healthy mind leads to a happier view of life and with a happier view of life it is much easier to counter the negative impact other issues will have on us.” – Catherine Pulsifer 

PNA Spotlight: Dr. Jamie Van Gompel

This month the PNA Spotlight focuses on longtime PNA member Dr. Jamie Van Gompel, a neurosurgeon at Mayo Clinic in Rochester, Minnesota.  Dr. Van Gompel earned a B.S. in molecular biology, biochemistry, medical microbiology and immunology, and then his M.D. at the University of Wisconsin.  He earned a certificate in Clinical and Translational Research at Mayo Clinic, where he also did residencies as a clinician investigator and in neurologic surgery. He then completed a fellowship in skull base and complex cranial surgery at the University of South Florida.  He was kind enough to answer some questions from the PNA.

Tell us about your educational journey.

At the University of Wisconsin as an undergraduate, I did a couple of majors, including molecular biology, immunology and medical microbiology and then biochemistry.  When I found out at college that you could pay the same amount and take over 18 credits, I would load up, so I got all those in four years. In between my undergraduate work and medical school, I worked for the National Institutes of Health (NIH) for a period of time. I was really interested in infectious diseases, so I worked at the Rocky Mountain Lab in Montana, researching bacteria.  It served as a high-level pathogen facility, much like the one at the Centers for Disease Control in Atlanta.  So, it’s a cool place to work; I really enjoyed it. And then we could go fly fishing at lunchtime on the river. It was fun.

Read More Here

Cushing’s Disease and the Role of Multidisciplinary Care

For many patients facing pituitary challenges, the road to a diagnosis of Cushing’s disease can be a long and frustrating one. Symptoms tend to develop slowly, often resembling more common conditions such as weight gain, high blood pressure, diabetes, or mood changes. By the time patients learn they have a pituitary tumor, they may have already lived with years of uncertainty.

“One of the key challenges in Cushing’s disease is that it’s very hard to diagnose, and there are often long diagnostic delays,” said Dr. Aditi Kumar, endocrinologist at Mayo Clinic. “The symptoms are very slow in onset, and they may mimic common conditions like diabetes, hypertension, obesity, depression, or anxiety. And it’s a very rare condition as well.”

Cushing’s disease occurs when a small, benign tumor in the pituitary gland causes excess production of cortisol, a hormone that regulates many of the body’s functions. Because stress and certain medications can also affect cortisol levels, testing to confirm the disease is complex. It often involves blood tests, urine tests, and salivary cortisol testing. The results can be challenging to interpret, making referral to an expert endocrinologist especially important when Cushing’s is suspected.

“Our team at Mayo Clinic has extensive experience with inferior petrosal sinus sampling, a test that can help determine whether excess cortisol is coming from the pituitary gland,” said Dr. Bernard Bendok, neurosurgeon and chair of neurosurgery at Mayo Clinic in Arizona.

Treatment usually begins with surgery to remove the tumor. “After that, patients must be followed very closely because even after initial surgery, there’s a chance that the condition can recur,” Dr. Kumar said. “It also has a huge impact on the mental and emotional health of patients, so they need a lot of support during the whole process of diagnosis, treatment, and recovery.”

At Mayo Clinic, that support comes from surrounding the patient with a diverse team of experts. “Our strength is that we have a multidisciplinary team of specialists to take care of these patients,” Dr. Kumar said. Endocrinologists work alongside neurosurgeons, neuroradiologists, neuro-ophthalmologists, ENT specialists, and radiation oncologists. Mayo also uses advanced tools such as seven-Tesla MRI, which can detect very small tumors that may not be visible on standard scans.

Advances in surgical techniques have further improved outcomes. “Advancements in endoscopic surgery have significantly enhanced the visualization of the pituitary gland, making surgeries for Cushing’s disease more precise,” said “Additionally, the integration of virtual and augmented reality has revolutionized our ability to incorporate preoperative imaging into the surgical plan in real time. Access to world-class neuropathology is crucial for intraoperative decision-making. The use of intraoperative ultrasound is an exciting new frontier, aiding in the detection of very small lesions,” Dr. Bendok added.

Researchers at Mayo Clinic are also exploring robotic approaches to make surgery even more precise in and around the pituitary gland, further advancing patient care.

Mayo’s high-tech, team-focused approach also helps patients avoid repeated visits and delays. “We try to bundle up appointments so that patients are able to make the most of their visit and that diagnosis and treatment can proceed very quickly,” Dr. Kumar said.

Even after surgery, most patients continue to need close attention. Larger or more invasive tumors may not be able to be completely removed, and Cushing’s disease can recur. This is why ongoing follow-ups are essential. With Mayo’s multidisciplinary team and long-term support, patients can face Cushing’s disease with more hope and clarity, knowing they are not alone in their journey.

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

PNA Medical Corner: Sinonasal Quality of Life After Pituitary Surgery

This month the PNA Medical Corner showcases a study coauthored by Dr. Juan Fernandez-Miranda at Stanford University, a member of the PNA. The study finds that patients with functional tumors have a longer period of healing in the sinus cavity, compared to patients with non-functional tumors. 

Dr. Juan Fernandez-Miranda

Functionality of Pituitary Tumors Impacts Sinonasal Quality of Life Before and After Endoscopic Surgery

Yossawee Wongworawut 1, Peter H Hwang 2, Jayakar V Nayak 2, Robert Dodd 3, Juan C Fernandez-Miranda 3, Zara M Patel 2
Affiliations Expand
• PMID: 40960129     DOI: 10.1002/lary.70116

Abstract
Objectives: Local effects of pituitary hormones in the sinonasal region are not well characterized. We sought to examine sinonasal quality of life outcomes in functional and non-functional pituitary tumors after endoscopic skull base surgery.

Study design: Retrospective Medical Record Review.

Methods: Three hundred four patients who received endoscopic resection of a pituitary tumor at a tertiary skull base center reviewed. This population was divided into non-functional and functional groups. Surgical outcomes and pre and postoperative quality of life scores were examined.

Results: Preoperative total SNOT 22 scores were not different overall between the two groups, but the rhinologic and extra-nasal rhinologic subdomain scores in the functional group were higher than in the non-functional group (3.57 ± 3.95 vs. 2.58 ± 3.64, and 1.48 ± 2.2 vs. 0.92 ± 1.75 respectively) (p = 0.04 and 0.02). Change from baseline in overall postoperative SNOT 22 score was significantly greater in the functional group at 6 weeks post-operation (6.75 ± 17.51 vs. 1.4 ± 16.83 respectively) (p = 0.03). Time to normalization on nasal endoscopy was longer in the functional group compared to the non-functional group (p = 0.02).

Conclusion: Corticotrophic and somatotrophic tumors affect quality of life both pre- and post-operation. Patients with functional tumors took longer to reach full healing and normalization of the sinus cavity. These findings can be used to counsel patients about different expectations during the immediate postoperative healing period, but also to reassure them that regardless of tumor functionality, they will be able to reach a good quality of life after endoscopic skull base surgery.

Keywords: pituitary adenoma; pituitary tumor; sinonasal outcome test; skull base; skull base neoplasm.

© 2025 The American Laryngological, Rhinological and Otological Society, Inc.

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)

“Your body holds deep wisdom. Trust in it. Learn from it. Nourish it. Watch your life transform and be healthy.”

– Bella Bleue 

PNA Spotlight: Dr. Yuval Eisenberg

This month the PNA Spotlight shines on Dr. Yuval Eisenberg.  Dr. Eisenberg graduated from Rush Medical College at Rush University Medical Center in 2009. He works in Chicago, IL and two other locations and specializes in internal medicine as well as endocrinology, diabetes & metabolism.    Dr. Eisenberg is also affiliated with the University of Illinois Hospital Health & Science Center.  He was kind enough to answer some of our questions:

What inspired you to choose your career path?

My career path was guided by my interaction with patients and my mentors. The highlight of my medical school training was helping to diagnose a young man suffering from multiple endocrine neoplasia type 1 (MEN1), a rare genetic disorder causing multiple tumors, including a pituitary adenoma. Listening to his concerns and thinking outside the box, I helped provide him with the correct diagnosis and treatment plan – and started my journey into endocrinology. I have been fortunate to work with excellent clinician-educators in my career. Learning about and observing the care of patients with endocrine-related problems was fascinating and rewarding. The farther I got in my training, the more I realized that endocrinology was my passion and that patients with pituitary disorders would be my sub-focus. Patients with pituitary disease are a unique population who are in need of education, support and reassurance at diagnosis – and they often require long-term follow-up. This allows for time to develop a bond of trust; an aspect of medical practice I thoroughly enjoy.

Read More Here

Safeguarding the nose during pituitary tumor surgery

Pituitary tumors are typically removed through the nose during endoscopic transnasal transsphenoidal surgery. Although minimally invasive, that approach requires expertise to minimize surgical trauma to the nose. Fortunately, surgeons are using new techniques that help safeguard the nose and maximize patients’ quality of life after surgery.

“The tendency now is to be less invasive in the approach through the nose,” explains Dr. Carlos D. Pinheiro Neto, a Mayo Clinic ENT/head and neck surgeon. “A very aggressive approach can cause chronic nasal crusting and infections, scabbing, decreased sense of smell and taste, and changes in the nose’s appearance.”

In endoscopic transnasal transsphenoidal surgery, a small surgical camera and surgical instruments are placed through the nostrils to access the tumor through the sinuses. Mayo Clinic was among the first institutions to extensively research the approach. As initially developed, the procedure involved extensive nasal resection.

“The idea was to create a maximum opening of the sinuses to allow neurosurgeons to reach and remove the tumor from the skull base,” Dr. Pinheiro Neto says. “The nasal physiology and sinus symptoms after the surgery were not a priority — the nose was just a corridor to the tumor.”

Now, Dr. Pinheiro Neto is pioneering surgical techniques that minimize resection of the nasal and sinus structures. One involves leaving intact the middle turbinate, which plays important roles in nasal airflow, warming and filtering air to the lungs, and smelling. Another is using a nasal-floor graft to provide a seal between the nose and brain after tumor removal. The standard procedure when cerebrospinal fluid leaks during surgery involves a nasal septal flap created from the septum — the tissue that separates the nostrils’ two airways.

“Nasal graft is much better for patients. It avoids the exposure of the nasal septum cartilage, so there is less crusting and faster healing,” Dr. Pinheiro-Neto says. “Nasal septal flaps can also cause a structural collapse in the nasal bridge and increase the risk of septal perforations. Since changing our paradigm from nasal septal flap for pituitary surgery, our leak rate is 0.1%.”

The new techniques are based on research conducted in Mayo Clinic’s anatomy laboratory. Those lessons are translated to the operating room, where ENT/head and neck surgeons routinely work alongside neurosurgeons to remove pituitary tumors.

“That research has allowed us to achieve the same level of tumor resection and treatment outcomes, but with fewer complications,” Dr. Pinheiro-Nato says. “With time and experience, we have realized it’s possible to preserve most of the nose and still get good space in the back of the sinus for tumor removal.

“This is about improving patients’ quality of life,” Dr. Pinheiro-Neto says. “They can have a nasal procedure but after a few weeks of healing, the nose and nasal physiology, and the sinuses, are as good as ever before.”

Stanford Hosts Pituitary Patient Education Day

Stanford University invites the public to their free pituitary patient education day, to be held both in-person and via zoom on Saturday November 9th, 2024. The event will run from 8am-5pm and will take place in the Assembly Hall at Stanford Hospital.

The course co-directors include neurosurgeon Juan C. Fernandez-Miranda, MD (a longtime member of the PNA), and endocrinologist Julia Chang, MD. Topics to be discussed include the function of the pituitary gland, endonasal endoscopic surgery, cavernous sinus surgery, radiotherapy, Cushing’s, acromegaly, prolactinoma and more.

Click To Sign Up 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)

This month the PNA Spotlight focuses on endocrinologist Dr. Leena Shahla, director of the Duke Pituitary Center, part of Duke Health in Durham, North Carolina.  The program is listed by the PNA as a center of pituitary excellence. Dr. Shahla graduated medical school at Al-Baath University (in Homs, Syria), did her residency in internal medicine at St. Joseph’s at New York Medical College, and completed a fellowship in endocrinology at the University of Massachusetts Medical School. Her pituitary focus has grown significantly over the years.   She initiated the pituitary tumor board at the University of Florida, Jacksonville, and later built the pituitary clinic at the University of Arizona, Phoenix. She arrived at Duke this past July.  Dr. Shahla was kind enough to answer a few questions from the PNA. Below is the conversation.

Please tell us about your work at Duke.

At Duke, I am the neuroendocrinologist and medical director of Duke Pituitary Center. Our multidisciplinary team includes specialists in neurosurgery, neuro-ophthalmology, ENTs, neuro-oncology, and neuro-radiology.  We run a multi-disciplinary clinic. When patients visit for evaluation, they often start with visual field testing, followed by appointments with me and one of the neurosurgeons, all in one place. We all collaborate closely behind the scenes to make the best plan for each patient.

What inspired you to choose this career path?

My interest in hormones and their role in regulating various physiological systems led me to specialize in endocrinology. And then, as I realized the significant impact of the pituitary on the endocrine system, I found the challenge of diagnosing and treating pituitary conditions fascinating, much like solving a complex puzzle. So ultimately, that inspired me to specialize in pituitary disorders.

What is the primary focus of your work or research?

We’re working on a study on the link between hypogonadism and prolactinoma. We are also going to be looking into early diagnosis of Cushing’s and acromegaly.

How has endocrinology evolved since you got into it, and where do you think it’s going?

Medicine today is more advanced than ever.  Especially in my specialty, there have been advancements in pituitary-focused diagnostic tests and new treatments continue to emerge. This progress is especially beneficial for complex cases that previously had limited treatment options. The field is moving forward with studies and clinical trials underway. Cushing’s and acromegaly are rare diseases and often leave patients suffering for years before diagnosis. However, with greater public awareness and improved testing, patients are being diagnosed earlier.

What should patients know about endocrinology? What needs more awareness?

Cushing’s Syndrome and acromegaly deserve more awareness, as many patients go undiagnosed for long periods. Not all cases present with obvious symptoms making it crucial for primary care physicians and other providers to recognize early signs. When patients are diagnosed in advanced stages, treatment becomes more challenging. Raising awareness can guide physicians to screen for Cushing’s syndrome and acromegaly or refer patients to endocrinology. This proactive approach can help us identify, diagnose, and treat patients sooner.

What are some of the signs that doctors and patients should be looking for, for acromegaly and Cushing’s?

Both patients and providers should be aware of certain signs and symptoms, although they can be subtle or develop gradually.

For Cushing’s, signs could be unexplained weight gain, easy bruising, muscle weakness, mood changes (anxiety, depression, irritability), uncontrolled diabetes, or hypertension.

For acromegaly, some of signs are facial changes, hand and feet growth (increased ring or shoe size), joint pain and swelling, tingling in hands, jaw changes or pain, and widening of spaces between the teeth.

Early detection of these signs combined with diagnostic tests can help lead to timely intervention and management

What would you like to convey about yourself to your patients?

I believe that the doctor-patient relationship is built on communication, empathy, and trust. I am thorough in my approach, and when I meet patients, especially for the first time, I prioritize listening to their concerns, making sure I answer their questions and explain their conditions clearly so they understand. And I involve them actively in the decision-making process.

Empathy is essential, especially during the diagnosis and early stages of treatment before patients start feeling better. They need support, hand-holding, and understanding because they are often struggling physically, mentally, and emotionally. It is important to listen to their concerns patiently and guide them without getting frustrated. While we may not be able to cure everything, we can keep the disease very well-controlled, allowing them to feel better and supported.

What made you want to get involved with the PNA?

I always wanted to be involved with the PNA because pituitary disorders are not that common, and this group provides invaluable support to patients. My goal is to contribute as much as possible to help patients and community providers recognize the disease early.  Patients must be referred to centers with the right resources for diagnosis and treatment. At the end of the day, we all care deeply about our patients’ well-being.

“Your body holds deep wisdom. Trust in it. Learn from it. Nourish it. Watch your life transform and be healthy.”

– Bella Bleue 

PNA Spotlight: Dr. Yuval Eisenberg

This month the PNA Spotlight shines on Dr. Yuval Eisenberg.  Dr. Eisenberg graduated from Rush Medical College at Rush University Medical Center in 2009. He works in Chicago, IL and two other locations and specializes in internal medicine as well as endocrinology, diabetes & metabolism. Dr. Eisenberg is also affiliated with the University of Illinois Hospital Health & Science Center.  He was kind enough to answer some of our questions:

What inspired you to choose your career path?

My career path was guided by my interaction with patients and my mentors. The highlight of my medical school training was helping to diagnose a young man suffering from multiple endocrine neoplasia type 1 (MEN1), a rare genetic disorder causing multiple tumors, including a pituitary adenoma. Listening to his concerns and thinking outside the box, I helped provide him with the correct diagnosis and treatment plan – and started my journey into endocrinology. I have been fortunate to work with excellent clinician-educators in my career. Learning about and observing the care of patients with endocrine-related problems was fascinating and rewarding. The farther I got in my training, the more I realized that endocrinology was my passion and that patients with pituitary disorders would be my sub-focus. Patients with pituitary disease are a unique population who are in need of education, support and reassurance at diagnosis – and they often require long-term follow-up. This allows for time to develop a bond of trust; an aspect of medical practice I thoroughly enjoy.

Read More Here

Safeguarding the nose during pituitary tumor surgery

Pituitary tumors are typically removed through the nose during endoscopic transnasal transsphenoidal surgery. Although minimally invasive, that approach requires expertise to minimize surgical trauma to the nose. Fortunately, surgeons are using new techniques that help safeguard the nose and maximize patients’ quality of life after surgery.

“The tendency now is to be less invasive in the approach through the nose,” explains Dr. Carlos D. Pinheiro Neto, a Mayo Clinic ENT/head and neck surgeon. “A very aggressive approach can cause chronic nasal crusting and infections, scabbing, decreased sense of smell and taste, and changes in the nose’s appearance.”

In endoscopic transnasal transsphenoidal surgery, a small surgical camera and surgical instruments are placed through the nostrils to access the tumor through the sinuses. Mayo Clinic was among the first institutions to extensively research the approach. As initially developed, the procedure involved extensive nasal resection.

“The idea was to create a maximum opening of the sinuses to allow neurosurgeons to reach and remove the tumor from the skull base,” Dr. Pinheiro Neto says. “The nasal physiology and sinus symptoms after the surgery were not a priority — the nose was just a corridor to the tumor.”

Now, Dr. Pinheiro Neto is pioneering surgical techniques that minimize resection of the nasal and sinus structures. One involves leaving intact the middle turbinate, which plays important roles in nasal airflow, warming and filtering air to the lungs, and smelling. Another is using a nasal-floor graft to provide a seal between the nose and brain after tumor removal. The standard procedure when cerebrospinal fluid leaks during surgery involves a nasal septal flap created from the septum — the tissue that separates the nostrils’ two airways.

“Nasal graft is much better for patients. It avoids the exposure of the nasal septum cartilage, so there is less crusting and faster healing,” Dr. Pinheiro-Neto says. “Nasal septal flaps can also cause a structural collapse in the nasal bridge and increase the risk of septal perforations. Since changing our paradigm from nasal septal flap for pituitary surgery, our leak rate is 0.1%.”

The new techniques are based on research conducted in Mayo Clinic’s anatomy laboratory. Those lessons are translated to the operating room, where ENT/head and neck surgeons routinely work alongside neurosurgeons to remove pituitary tumors.

“That research has allowed us to achieve the same level of tumor resection and treatment outcomes, but with fewer complications,” Dr. Pinheiro-Nato says. “With time and experience, we have realized it’s possible to preserve most of the nose and still get good space in the back of the sinus for tumor removal.

“This is about improving patients’ quality of life,” Dr. Pinheiro-Neto says. “They can have a nasal procedure but after a few weeks of healing, the nose and nasal physiology, and the sinuses, are as good as ever before.”

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)