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.”

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 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 by 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.

What is the primary focus of your work/research?

My main focus is my clinical endocrinology practice, and I see a variety of patients, but I have a specialized interest in patients with pituitary disorders. My research interest is in the hormone oxytocin and how it might affect patients with pituitary hormone deficiencies (hypopituitarism).

What do you consider to be the future of your field?

In my opinion, the future is in specialized and individualized expert care when providing for patients with pituitary disorders. Given the rarity of these diseases, patients are best served by providers with interest and experience. Also, the more we know about pituitary tumors and the genetics behind them, the better we will be able to predict patient outcomes and tailor our therapies.

What should patients know about your field/what deserves more recognition/awareness?

My feeling is that patients need to know that they can/should advocate to get the care they deserve from providers with interest and experience in caring for individuals with their condition. They should also utilize the excellent patient-centered resources (like the PNA) to help educate and direct their care.

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

The best part of my job is helping patients (and their families) understand their condition, their prognosis and their options. It’s tremendously rewarding to help someone feel more comfortable with what is often a completely foreign, and sometimes scary sounding group of diseases. I strive to always spend the time and energy needed to make patients feel more at ease with and educated about their disease.

• Why did you get involved with the PNA and what is the extent of your involvement?

Early in my career, I became excited to become more involved. My mentor has also been involved in the PNA for many years and recommended I become involved, as he found it an excellent resource for patients and providers.

“The human body is the best picture of the human soul.” – Tony Robbins

PNA Spotlight: Phillip Cem Cezayirli, MD

This month the PNA Spotlight focuses on neurosurgeon Dr. Philip Cem Cezayirli, part of the Haynes Neurosurgical Group in Birmingham, Alabama. Dr. Cezayirli is affiliated with four local medical centers: Princeton Baptist, Shelby Baptist, Grandview, and Brookwood Baptist Medical Centers.

Dr. Philip Cezayirli

He is a board-certified neurosurgeon with a focus on neurosurgical oncology and spine surgery and is licensed to practice neurosurgery in Alabama.

He earned his MD at the University of Alabama at Birmingham School of Medicine in Birmingham, Alabama. He spent a year studying with Dr. Uğur Türe at Yeditepe University and Hospital in Istanbul, Turkey. He did his neurosurgery residency at the Albert Einstein College of Medicine in Montefiore, Bronx New York. And he completed a neurosurgical oncology fellowship at MD Anderson Cancer Center in Houston, TX.

Dr. Cezayiri was kind enough to speak with the PNA about a range of issues. Here is the conversation, edited for clarity.

Read More Here

Expertise needed for tumors that invade the pituitary’s protective layer

The pituitary gland is surrounded by the cavernous sinus and internal carotid artery. A thin layer of connective tissue separates the sinus and artery from the pituitary gland. Pituitary tumors sometimes invade this protective layer, called the medial wall of the cavernous sinus (MWCS).

That infiltration puts pituitary tumors in close proximity to the internal carotid artery and to cranial nerves, significantly complicating treatment approaches — especially when a tumor needs to be entirely removed to achieve cure.

“Standard procedure would be to resect the pituitary tumor up to the medial wall, to avoid damaging the artery. But if there’s tumor in the wall, the patient won’t be cured,” says Mayo Clinic neurosurgeon Dr. Kaisorn L. Chaichana.

MWCS infiltration is more common with functioning adenomas, such as prolactinomas and tumors that cause acromegaly or Cushing’s disease. Incomplete removal of these tumors can lower the chances of hormone control and increase the risk of tumor regrowth.

Fortunately, neurosurgeons are learning how to meet these challenges. Surgically removing part of the MCWS, to completely resect pituitary tumors, can improve outcomes.

“It’s a formidable challenge,” Dr. Chaichana says. “It takes people well-versed in the surgery, and who have experience, to know where they can open that medial wall. If you’re too far to the side — even by less than a millimeter — you would cut the carotid artery, which would be catastrophic.”

Mayo Clinic neurosurgeons use Doppler ultrasound to guide entry into the cavernous sinus, allowing selective resection of the MWCS. “We listen to the sound of the carotid artery, find a space within the medial wall where the artery isn’t present, and make a small slit in that opening,” Dr. Chaichana says. “Then we remove the wall from the carotid artery.”

It’s also important to limit packing of the cavernous sinus after surgery. “Overpacking that site can cause pressure and injury to the cranial nerves, which could lead to facial numbness and eye motion problems,” Dr. Chaichana says.

A multidisciplinary team that includes ENT/head and neck surgeons, as well as neurosurgeons, provides additional anatomical expertise.

“Very few centers do this procedure. But we’ve seen higher rates of remission for functional tumors when we take out that wall,” Dr. Chaichana says. “For a lot of functional tumors, selective resection of the MWCS can mean the difference between tumor remaining and tumor being gone — and therefore, cure or not cure.”

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)

Dr. Philip Cezayirli

This month the PNA Spotlight focuses on neurosurgeon Dr. Philip Cem Cezayirli, part of the Haynes Neurosurgical Group in Birmingham, Alabama. Dr. Cezayirli is affiliated with four local medical centers: Princeton Baptist, Shelby Baptist, Grandview, and Brookwood Baptist Medical Centers.
He is a board-certified neurosurgeon with a focus on neurosurgical oncology and spine surgery and is licensed to practice neurosurgery in Alabama.
He earned his MD at the University of Alabama at Birmingham School of Medicine in Birmingham, Alabama. He spent a year studying with Dr. Uğur Türe at Yeditepe University and Hospital in Istanbul, Turkey. He did his neurosurgery residency at the Albert Einstein College of Medicine in Montefiore, Bronx New York. And he completed a neurosurgical oncology fellowship at MD Anderson Cancer Center in Houston, TX.
Dr. Cezayiri was kind enough to speak with the PNA about a range of issues. Here is the conversation, edited for clarity.
Tell me about your practice – what do you want pituitary patients to know?
I am from Birmingham, Alabama and work here now, but I did med school here at U.A.B., and then I did my training for residency up in New York at Albert Einstein College of Medicine and Montefiore Medical Center. Then I did a fellowship in Istanbul, Turkey, with Professor Mahmut Gazi Yaşargil and his mentee, Dr. Uğur Türe, in microsurgical neuroanatomy and micro neurosurgery training.
Later, I went back to my chief residency year at Einstein at Montefiore where I trained with Dr. Vijay Agarwal, a pituitary specialist who trained with the Mayo Clinic. During my fellowship in neurosurgical oncology at MD Anderson in Houston, Texas, I worked with neurosurgeons who focus on cancers of the brain, spine, skull base and nerves. We spend a third of our time working on the skull base, a large part of it, pituitaries.

What do you want patients to understand about your approach?
I think the important thing is our job is to help the patient, and so sometimes that means we don’t even need to operate. We can just watch the problem. Then sometimes, if it’s causing issues, or we think it’s going to cause issues, then we kind of have to weigh the risks and benefits with the patient. We try to use a patient-first approach. Just because we see something on imaging, that doesn’t necessarily mean we have to do surgery.
We focus on what the patient wants and needs and where they are in their life and try to balance all that. We are comprehensive and highly involved with the patient’s workup. For instance, we’ve had patients with a fairly large lesion, but they didn’t notice any vision problems. So, we waited to make sure. We got the labs and got the vision checked. The vision was completely normal, even though it looked like it was pushing on the nerves. And the labs actually came back showing that that the patient had a prolactinoma. So the patient ended up getting medical treatment with for the prolactinoma, and now the lesions smaller and the patient is completely fine.
We had another patient who was pregnant and had headaches. She got an MRI which showed a lesion in the pituitary, pushing on the nerves. But her vision was fine, and since she was in the third trimester, we watched it, and she delivered their baby. A repeat MRI three months later showed the pituitary is normal size now. So, we’ll continue to watch patients like that, just to make sure, but we don’t always have to do surgery. Our goal is to do right by the patient and focus on what they need and want.
I think it’s important with pituitary care in particular, that we use a team-based approach, and rather than it being just a neurosurgeon, an endocrinologist, an eye doctor or an E-N-T alone. We all work together to improve our patients’ outcomes.
What are the misconceptions out there that you want to clear up?
I think that there are people who may be afraid to get imaging, or afraid to see a neurosurgeon, because they think if we find something on the imaging, they’ll be forced to do surgery. That’s not how we work.
You know the old adage, when you’re a hammer, everything looks like a nail…
Right? And maybe 30 or 40 years ago, that might have been the case, especially when MRIs first came out, we would find lesions, and think that we had to operate on it. But now we know a lot more. And so, I don’t think there’s much downside to getting imaging or seeing a neurosurgeon when in doubt. Especially if you go to someone who has experience in this and understands the natural history of the diseases. No one is going to insist on surgery.
Also, there’s no downside to getting your vision checked regularly. A lot of times with pituitary problems, the vision issues can be so subtle and so slow that that you might miss them. It’s better to closely watch your health with your endocrinologist, primary care doctor, eye doctor and neurosurgeon, who are all of what symptoms can be there rather than avoiding diagnosis out of fear of needing surgery. It is much easier to preserve vision when people are doing well, than when the vision has been lost for a long period of time.

Why are you a member of the PNA? Why do you think it’s a worthy venture?
I think it’s good to have an official resource for people with a pituitary lesion and to have a support group. It’s very important for patients to know where to go and who to see and how to follow up. It’s very nice that the PNA maintains a provider directory of people who focus on lesions in the pituitary. An official, respected resource is important, so people don’t believe everything they read on the internet or social media.
Reach Dr. Cezayirli:
Haynes Neurosurgical Group
Cell: 2054825198
Office: 2057878676
Fax: 2057857944u
Email: [email protected]
Website: https://haynesneurosurgery.com
Address:
801 Princeton Ave SW
P. O. B. I, Suite 310
Birmingham, AL 35211-1307

“The human body is the best picture of the human soul.” – Tony Robbins

PNA Medical Corner:

Endogenous Cushing’s and Cancer

Dr. Maria Fleseriu

This month the PNA Medical Corner features a study co-authored by Maria Fleseriu, a  longtime member of the PNA and Professor of Endocrinology and Neurological Surgery and Director of the Pituitary Center at Oregon Health & Science University.  The study finds that endogenous Cushing’s Syndrome is linked to higher risk of cancer.

Eur J Endocrinol

2024 Jul 27:lvae098.

 doi: 10.1093/ejendo/lvae098. Online ahead of print.

Endogenous Cushing’s Syndrome and Cancer Risk

Yaron Rudman ^1 2, Maria Fleseriu ³, Laura Dery ², Hiba Masri-Iraqi ^1 2, Liat Sasson ^1 2, Tzipora Shochat ⁴, Shiri Kushnir ⁵, Ilan Shimon ^1 2, Amit Akirov ^1 2

Affiliations Expand

• PMID: 39067000    DOI: 10.1093/ejendo/lvae098

Abstract

Objective: Cancer incidence in patients with endogenous Cushing’s syndrome (CS) has never been established. We aimed to assess the cancer risk in patients with CS, as compared with individually matched controls.

Design: A nationwide retrospective matched-cohort study of patients with endogenous CS diagnosed between 2000-2023, using the database of Clalit Health Services in Israel.

Methods: Patients with adrenal carcinoma or ectopic CS were excluded. Patients with CS were matched in a 1:5 ratio, with controls individually matched for age, sex, socioeconomic status, and body mass index. The primary outcome was defined as the first diagnosis of any malignancy following a CS diagnosis. Risk of malignancy was calculated using the Cox proportional hazards model with death as a competing event.

Results: A total of 609 patients with CS and 3018 controls were included [mean age at diagnosis, 48.0±17.2 years; 2371 (65.4%) women]. The median follow-up 14.7 years (IQR, 9.9-20.2 years).Patients with CS had an increased cancer risk, with hazard ratio (HR) of 1.78 (95% CI 1.44-2.20), compared with their matched controls. The risk of malignancy was elevated in patients with Cushing’s disease (251 cases and 1246 controls; HR 1.65, 95% CI 1.15-2.36) and in patients with adrenal CS (200 cases and 991 controls; HR 2.36, 95% CI 1.70-3.29). The increased cancer risk in patients with CS persists after exclusion of thyroid malignancies.

Conclusion: Endogenous CS is associated with increased malignancy risk. These findings underscore the need for further research to establish recommendations for cancer screening in this population.

Keywords: Adrenal; Cancer; Cushing’s disease; Cushing’s syndrome; Malignancy; Pituitary.

© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

Reversing vision loss with successful pituitary tumor surgery

Pituitary tumors often cause vision problems. That’s because the optic nerves, which connect the eye to the brain, are located just on top of the pituitary gland. Pituitary tumors can grow

in a way that causes them to compress the optic nerves, leading to vision loss.

“Often the visual loss starts with the peripheral vision and is quite subtle,” says Mayo Clinic neurosurgeon Dr. Maria Peris Celda. “Pituitary tumors usually grow slowly and over time, people can get used to the visual loss. They may not notice the problem until the larger tumor affects their central vision.”

Fortunately, vision loss is often reversed once the tumor is surgically removed. The most common procedure is endoscopic endonasal transsphenoidal surgery. The endoscope, a small surgical camera, and surgical instruments are placed through the nostrils to access the tumor through the sinuses.

“We don’t have to make any incisions in the face,” Dr. Peris Celda says. “Very often, the visual loss either improves or is completely resolved after the operation.” Mayo Clinic was among the first institutions to extensively research the endoscopic through-the-nose approach. Now standard practice, the procedure lowers discomfort and usually requires only an overnight stay in the hospital.

ENT nose and sinus surgeons work alongside neurosurgeons during these procedures. For challenging cases, patients can benefit from the care provided by neuro-ophthalmologists: subspecialists who treat vision issues linked to neurological conditions.

Successful pituitary tumor surgery requires detailed imaging. “The pituitary gland is located in a delicate area, surrounded by very important blood vessels and nerves,” Dr. Peris Celda says. “Using the latest MRI technology allows us to understand the relationship between the tumor, brain and other important structures.”

Vision problems are just one type of complication that pituitary tumors can cause. “A specialized team that focuses on skull base diseases can help provide patients with the best possible outcomes and return to normal quality of life,” Dr. Peris Celda says.

Mayo Clinic is one of the leading pituitary centers in the U.S.  For more information, please visit careinfo.mayoclinic.org/pituitary-tumor 

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)