News Articles February 2022

Written on 04 February 2022.

News Articles June 2025

News Articles June 2025

New imaging tool to diagnose Cushing’s?

An article in Cushing’s Disease News looks at a study that find that a new form of PET scan, alongside a CT  scans can detect tumors that produce ACTH, common in Cushing’s disease. Read more:

https://cushingsdiseasenews.com/news/imaging-technique-found-accurately-id-cushings-pituitary-tumors/

Exercise and hormonal health

An article in mindbodygreen.com examines the effect of exercise on your hormones. Read more: https://www.mindbodygreen.com/articles/how-high-intensity-exercise-impacts-cortisol-and-other-hormones

Pituitary patient describes afterlife following near-death experience

A story on MSN.com relates the experiences of Brianna Lafferty, a pituitary patient who was clinically dead for 8 minutes. She now works as a transition guide. Read more here:

https://www.msn.com/en-us/health/medical/woman-who-died-for-8-minutes-claims-death-is-an-illusion-as-she-recalls-afterlife/ar-AA1FuWo5

PNA Highlights June 2025

“Let thy food be thy medicine and thy medicine be thy food.” – Hippocrates

PNA Spotlight: Dr. Shaan Raza

This month the PNA Spotlight focuses on Dr. Shaan Raza, Professor of Neurosurgery and Neurosurgical Director of the Multidisciplinary Skull Base and Pituitary Program at The University of Texas MD Anderson Cancer Center in Houston.  He is also Section Chief for Skull Base Surgery and Vice-Chair in the Department of Neurosurgery. He attended medical school at Johns Hopkins in Baltimore, where he also did a neurosurgery residency.  Then he went to MD Anderson to do a skull base fellowship. Later he went to Cornell New York Presbyterian in New York City to do an endoscopic skull base fellowship.  After concluding his training, he began practicing at MD Anderson.  Dr. Raza was kind enough to answer some questions from the PNA. Here are his answers.

Please describe your practice.

I’m neurosurgical director of our multidisciplinary skull base and pituitary programs, and so my entire surgical practice focuses on skull base pathology, including pituitary pathology.

What inspired you to go into that field?

Specifically, within neurosurgery, I thought that the management of skull base and pituitary pathology was the most interesting from the standpoint that with the right treatments, you can really make an impact on patients in terms of their quality of life, such as restoring vision, restoring pituitary gland function, and improving survival. What also fascinated me about pursuing this area within neurosurgery is the tumor biology. We knew so little at the time when I was going through training compared to how much more we know now. It is such a rapidly evolving field. But also, I am interested in the surgical strategies, these highly intricate procedures that require an extremely thorough understanding of anatomy and require a lot of focus and intensity.  With the right surgical strategies, you really can make a difference in patients’ lives. So for all those reasons, I wanted to be part of this evolving and innovative field.

Read More Here

 

How Virtual and Augmented Reality are Transforming Pituitary Surgery

Pituitary tumors can drastically impact the quality of patients’ lives. Some disrupt hormone production, causing symptoms throughout the body. Others grow large enough to press against the optic nerves, leading to vision problems. While surgery is often necessary, it’s far from simple. The pituitary gland is surrounded by delicate and vital structures. Even small differences in individual anatomy can turn a straightforward procedure into a complex challenge.

Now, thanks to emerging advances in virtual and augmented reality, surgeons can plan and rehearse these procedures with a level of precision and personalization previously not possible.

“The secret of successful pituitary surgery is to really understand the nuances of the individual patient’s anatomy,” says Dr. Bernard Bendok, Neurosurgeon and Chair of Neurosurgery at Mayo Clinic in Phoenix. “With 3D imaging and virtual reality, you can build a detailed plan in your mind before you operate—one that helps you navigate around critical structures, like the carotid arteries, more safely.”

https://drive.google.com/file/d/1AV1MUNJaTR6MQzGtGAaMJ7vUlbHQc3_5/view

DESCRIPTION COPY: Explore a virtually rendered fly-through of the skull, pituitary gland, and tumor used in surgical planning at Mayo Clinic. Watch it here. LINK FOR VIDEO:

 Dr. Bendok likens it to the way pilots practice in flight simulators, or how military personnel have adopted VR and AR technology to plan and train for operations. These tools give surgeons—and the teams that support them—a risk-free environment to rehearse complex cases before ever setting foot in the operating room.

“I’m a big believer that simulation training is absolutely fundamental,” says Dr. Bendok, “because we cannot just learn in the OR—we have to learn outside the OR, where we can create rare scenarios.”

This type of immersive practice is shortening the learning curve for surgeons, allowing them to gain deeper experience and confidence more quickly—especially in high-stakes procedures like pituitary tumor removal.

“If we compare learning curves with this approach versus 10 or 20 years ago, we can accelerate them significantly,” says Dr. Bendok. “Every musician knows that rehearsal leads to better performance—and the same is true for surgery. In the past, rehearsal meant working with cadavers or simply gaining experience case by case. But now, we can be more self-reflective and more individualized in our preparation.”

The potential is enormous. VR- and AR-enhanced surgery doesn’t just make procedures safer—it also enables global collaboration. Surgeons can share rare or complex cases, offering peers around the world the chance to learn from unique anatomies and pathologies. It’s a shift that has the potential to raise the standard of care globally.

As an early adopter of this fast-evolving technology, Dr. Bendok and his team at Mayo Clinic have a bold vision. Their aim is to drive widespread transformation with it—not only in how surgeries are planned and performed, but also in how surgeons train and gain meaningful experience. To make this a reality, Mayo Clinic and their partners are developing online platforms that will eventually give more surgeons access to these virtual simulation tools—regardless of their location. The goal is not just to improve individual outcomes, but to multiply expertise at scale.

“In my career, I may help 10,000 patients through direct surgery,” Dr. Bendok says. “But if we can use this technology to help train others and scale better outcomes worldwide, the impact becomes exponential.”

For people living with the unpredictable and often life-altering symptoms of pituitary conditions like Cushing’s Syndrome, the result can be more than just a safer and successful surgery. It can be a chance to reclaim their well-being and quality of life.

 

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

 

PNA Medical Corner: The PANOMEN-3 grading score

This month the PNA Medical Corner focuses on a study coauthored by longtime PNA member Dr. Maria F

leseriu. The data evaluated more than 400 patients with pituitary tumors using a grade system recently developed by the Pituitary Society.  The results show that the PANOMEN-3 grade system is successful in predicting the long-term outcomes and should be used in clinical practice.

PANOMEN-3 grading score is reliable in predicting pituitary adenoma behavior and prognosis: a single center cohort study

Alessandro Mondin 1 2Giulia Bovo 1 2Mattia Barbot 1 2Maria Fleseriu 3Luca Denaro 4Carla Scaroni 1 2Filippo Ceccato 5 6

Affiliations Expand

PMID: 40455176   DOI: 10.1007/s12020-025-04292-x   https://pubmed.ncbi.nlm.nih.gov/40455176/

Abstract

Background: Pituitary adenomas (PAs) comprise a heterogeneous group of diseases: a scoring system to guide prognosis and therapy is still missing.

Methods: We assessed a retrospective single-center cohort of 401 patients with PAs followed over the last two decades using a newly developed Pituitary Society grading system, PANOMEN-3.

Results: A high initial grade of the adenoma predicted a worse long-term outcome despite multimodal treatments (grade 3, disease remission OR 0.49, 95%CI [0.27; 0.84], p = 0.01). The grade could predict tumor behavior following surgery: a higher grade at baseline predicted relapses after disease remission (grade 3 vs grade 1/2, p = 0.01) and a higher postoperative grade predicted the need for additional treatments in case of persisting disease (grade 2/3 vs grade 1, p = 0.02). A score downgrade obtained with primary medical predicted the reduction of additional interventions and long-term biochemical control. When considering CD patients, both a lower initial grade (grade 2 vs grade 3, p < 0.01) and preoperative eucortisolism (p = 0.04) reduced recurrence risk. Contrarily to the whole-cohort analysis, grade predicted the surgical outcome in non-functioning pituitary adenomas and in acromegaly.

Conclusion: Our data suggest for the first time that PANOMEN-3 grade system could be useful in everyday clinical practice, aiding physicians in both improving follow-up strategies for patients in remission and in the management of persisting disease for all pituitary adenomas. Especially for CD, a high initial grade could encourage clinicians to institute preoperative medical treatment and to adopt a closer follow-up schedule in cured cases.

Keywords: Cushing’s disease; Grading system; Non-functioning pituitary adenoma; PANOMEN-3; Pituitary adenoma.

Featured News and Updates

Research Articles

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)

Copyright © 2024 Pituitary Network Association All rights reserved.

Disclaimer: PNA does not engage in the practice of medicine. It is not a medical authority, nor does it claim to have medical expertise. In all cases, PNA recommends that you consult your own physician regarding any course of treatment or medication.

Our mailing address is:
Pituitary Network Association
P.O. Box 1958
Thousand Oaks, CA 91358
(805) 499-9973 Phone - (805) 480-0633 Fax
Email [email protected]

You are receiving this Newsletter because you have shown interest in receiving information about our activities.

If you do not want to receive any more emails from PNA, Unsubscribe.

June 2025 Research Articles

Pituitary Tumors

Effect of antineoplastic drug therapies on carcinoma and aggressive pituitary tumors: a systematic review and meta-analysis.

Cardoso ABR, Zimmermann AC, Raverot G, Nunes-Nogueira VDS.Pituitary. 2025 Jun 2;28(3):70. doi: 10.1007/s11102-025-01541-0.

Impulse control disorders in pituitary adenoma: What do we know and what we still don’t know in almost two decades?

Kadioglu P, Glezer A.Pituitary. 2025 Jun 2;28(3):71. doi: 10.1007/s11102-025-01533-0.

Effect of antineoplastic drug therapies on carcinoma and aggressive pituitary tumors: a systematic review and meta-analysis.

Cardoso ABR, Zimmermann AC, Raverot G, Nunes-Nogueira VDS.Pituitary. 2025 Jun 2;28(3):70. doi: 10.1007/s11102-025-01541-0. 

Impulse control disorders in pituitary adenoma: What do we know and what we still don’t know in almost two decades?

Kadioglu P, Glezer A.Pituitary. 2025 Jun 2;28(3):71. doi: 10.1007/s11102-025-01533-0.

Clinico-pathological and molecular characteristics of pediatric-juvenile pituitary neuroendocrine tumors (PitNETs): A mono-institutional series.

Buccoliero AM, Giunti L, Ponticelli A, Innocenti L, Ricci F, Cetica V, Tirinnanzi B, Moscardi S, Stagi S, Sardi I, Mussa F, Genitori L, Scagnet M.Clin Neuropathol. 2025 Jun 2. doi: 10.5414/NP301685. Online ahead of print.

Pituitary Surgery


Use of a Septal Stapler to Secure a Septal Free Mucosal Graft to the Nasoseptal Flap Donor Site Following Endoscopic Endonasal Resection of a Pituitary Adenoma.

Miller JE, Fischer JL, Wang MB.J Neurol Surg Rep. 2025 Apr 23;86(2):e98. doi: 10.1055/a-2531-6140. eCollection 2025 Apr.

Hormonal health

The effect of MDMA on anterior pituitary hormones: a secondary analysis of a randomized placebo-controlled trial.

Atila C, Camerin SJ, Liechti ME, Christ-Crain M.Endocr Connect. 2025 Jun 1:EC-25-0254. doi: 10.1530/EC-25-0254. Online ahead of print.

Combined pituitary hormone deficiency with a novel GLI2 frameshift variant.

Matsuo Y, Adachi N, Mukai T, Kato S, Kato M, Tanaka H.Pediatr Int. 2025 Jan-Dec;67(1):e70082. doi: 10.1111/ped.70082.PMID: 40457737 No abstract available.

Effect of pubertal induction with combined gonadotropin therapy on testes development and spermatogenesis in males with gonadotropin deficiency: a cohort study.

Castro S, Ng Yin K, d’Aniello F, Alexander EC, Connolly E, Hughes C, Martin L, Prasad R, Storr HL, Willemsen RH, Dunkel L, Butler G, Howard SR.Hum Reprod Open. 2025 May 13;2025(2):hoaf026. doi: 10.1093/hropen/hoaf026. eCollection 2025.

Long-term pituitary function following transsphenoidal surgery for non-functional pituitary neuroendocrine tumor with apoplexy: a single-center retrospective analysis.

Zou D, Yang Y, Gao R, Ou Y, Luo J, Zhang Z, Yang T, Cheng J.Sci Rep. 2025 Jun 1;15(1):19226. doi: 10.1038/s41598-025-03053-0.

Safety and efficacy of endoscopic vs. microscopic approaches in pituitary adenoma surgery: A systematic review and meta-analysis.

Al-Dardery NM, Khaity A, Soliman Y, Ali MOM, Zedan EM, Muyasarah K, Elfakhrany MD.Neurosurg Rev. 2025 Jun 1;48(1):471. doi: 10.1007/s10143-025-03600-3.

 

Hormonal Health

The effect of MDMA on anterior pituitary hormones: a secondary analysis of a randomized placebo-controlled trial.

Atila C, Camerin SJ, Liechti ME, Christ-Crain M.Endocr Connect. 2025 Jun 1:EC-25-0254. doi: 10.1530/EC-25-0254. Online ahead of print.

Combined pituitary hormone deficiency with a novel GLI2 frameshift variant.

Matsuo Y, Adachi N, Mukai T, Kato S, Kato M, Tanaka H.Pediatr Int. 2025 Jan-Dec;67(1):e70082. doi: 10.1111/ped.70082.

 

PNA Spotlight: Dr. Shaan Raza

PNA Spotlight: Dr. Shaan Raza

This month the PNA Spotlight focuses on Dr. Shaan Raza, Professor of Neurosurgery and Neurosurgical Director of the Multidisciplinary Skull Base and Pituitary Program at The University of Texas MD Anderson Cancer Center in Houston.  He is also Section Chief for Skull Base Surgery and Vice-Chair in the Department of Neurosurgery. He attended medical school at Johns Hopkins in Baltimore, where he also did a neurosurgery residency.  Then he went to MD Anderson to do a skull base fellowship. Later he went to Cornell New York Presbyterian in New York City to do an endoscopic skull base fellowship.  After concluding his training, he began practicing at MD Anderson.  Dr. Raza was kind enough to answer some questions from the PNA. Here are his answers.

Please describe your practice.

I’m neurosurgical director of our multidisciplinary skull base and pituitary programs, and so my entire surgical practice focuses on skull base pathology, including pituitary pathology.

What inspired you to go into that field?

Specifically, within neurosurgery, I thought that the management of skull base and pituitary pathology was the most interesting from the standpoint that with the right treatments, you can really make an impact on patients in terms of their quality of life, such as restoring vision, restoring pituitary gland function, and improving survival. What also fascinated me about pursuing this area within neurosurgery is the tumor biology. We knew so little at the time when I was going through training compared to how much more we know now. It is such a rapidly evolving field. But also, I am interested in the surgical strategies, these highly intricate procedures that require an extremely thorough understanding of anatomy and require a lot of focus and intensity.  With the right surgical strategies, you really can make a difference in patients’ lives. So for all those reasons, I wanted to be part of this evolving and innovative field.

Who truly influenced you? Who were your mentors?

I have had so many mentors who influenced me over the years, dating back to my time at Johns Hopkins.  One who comes to mind is neurosurgeon Dr. Gary Gallia, who really brought endoscopic techniques to Hopkins while I was a resident there. The other person that influenced me while I was there was one of the endocrinologists, Dr. Robert Salvatori,  who focuses on pituitary pathology.    So, that was my initial introduction to pituitary pathology.  I also had tremendous mentors, such as Dr. Ian McCutcheon at M.D. Anderson and Dr. Ted Schwartz in New York,  where I did my endoscopic fellowship.  He is a tremendous surgeon. Another mentor was Franco De Monte. I’ve been fortunate to have a lot of mentors who’ve really taught me about the art of being a physician, about being a good surgeon, a thoughtful surgeon, and understanding how to tailor treatment strategies to the individual patient.

Where do you think the whole field is going? Where are we going to be in 10 years?

It’s hard to predict. I think when you look at tumor biology for pituitary pathology, we’ll have a better understanding of the different subtypes, hopefully a better understanding in terms of the role of surgery, radiation and then newer systemic therapy agents/medication options for the different types.

Hopefully with heightened awareness of pituitary disease, we can get people to the right doctors and shorten the time between onset and diagnosis.

Absolutely. And along those lines, in terms of healthcare delivery for diseases such as this, patients will be sent to specialized centers, to give them access.  The care delivery needs to innovate over time so that more patients have access to subspecialized care. We see this with surgical strategies and the ability to deal with pituitary tumors.  Where previously, a gross total resection was not feasible, I think, this is going to improve and innovate over time with a better understanding of anatomy, surgical techniques, and incorporation of surgical technology.  When I look at the management of recurrent tumors, I believe we are going to have more strategies there. In my practice at MD Anderson, I see a lot of patients who’ve had previous operations elsewhere, previous radiation therapy.  So, managing patients who have recurrent tumors presents a whole other host of challenges.   With regard to new surgical radiation medical strategies, I think that patient population is also going to evolve over time. And then I think overall, a lot of the data that we use to guide management strategies comes from smaller data sets, and so as different institutions work together and compile data together, I think we’ll have better evidence to guide treatment strategies.

What has been your involvement with PNA?

My involvement with PNA has been from educational standpoint.  When patients come to me for an opinion,  I typically connect them with the PNA as another source of information. I also keep track of the different research that your group also promotes.  What I really appreciate about the PNA is that it’s a great resource for patients to get information from an experienced source and to be able to connect with other patients. I think that is extremely important, and certainly that kind of support improves my ability to take care of patients.

Is there anything else you’d like to discuss?

What I really emphasize is multidisciplinary care and to patient-centered care.   Pituitary patients should seek out care at centers that not only provide the surgical expertise, but the endocrine and radiological expertise.  Coordinated multidisciplinary care is what we really emphasize at MD Anderson, and deep expertise.  I am proud of my colleagues, because everybody involved in the care of pituitary patients is specialized in that area; we don’t just dabble in it. And that expertise translates to better patient outcomes.

 

PNA Highlights October 2024

“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

Featured News and Updates

Research Articles

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)

Copyright © 2024 Pituitary Network Association All rights reserved.

Disclaimer: PNA does not engage in the practice of medicine. It is not a medical authority, nor does it claim to have medical expertise. In all cases, PNA recommends that you consult your own physician regarding any course of treatment or medication.

Our mailing address is:
Pituitary Network Association
P.O. Box 1958
Thousand Oaks, CA 91358
(805) 499-9973 Phone - (805) 480-0633 Fax
Email [email protected]

You are receiving this Newsletter because you have shown interest in receiving information about our activities.

If you do not want to receive any more emails from PNA, Unsubscribe.

News Articles October 2024

New acromegaly drug on the horizon

A new drug for treatment and long-term maintenance therapy for acromegaly is now on the horizon. Crinetics Pharmaceuticals recently submitted its first new drug application (NDA) to the U.S. Food and Drug Administration for paltusotine, which is a once-daily oral selectively-targeted somatostatin receptor type 2 nonpeptide agonist.

Crinetics says researchers used data from from 18 clinical trials in the application, including two Phase 3 trials that evaluated paltusotine for acromegaly in medically untreated and treated patients.   Patients tolerated the treatment well, the medication achieved biochemical control by maintaining IGF-1 levels and improved patients’ symptoms compared to placebo.   The company says it expects to hear back from the FDA by December.

Paltusotine, is the first drug of its type to complete Phase 3 clinical development for acromegaly and is now in Phase 2 clinical development for carcinoid syndrome associated with neuroendocrine tumors.  Read the company’s press release here. 

 

Can machine learning to predict hormone deficiency after pituitary surgery?

A study featured on Nature.com used machine learning algorithms to predict whether patients would develop arginine vasopressin deficiency after transsphenoidal surgery to remove a pituitary adenoma. Read more here: https://www.nature.com/articles/s41598-024-72486-w

 

Pituitary apoplexy strikes groom on wedding day

An article in People.com tells the story of a groom in England who had to leave his wedding reception early due to a severe headache – one that turned out to be a hemorrhaging pituitary tumor. Read more here: https://people.com/groom-migraine-wedding-day-tumor-popped-8718083

 

Researchers try to make synthetic oxytocin for pain relief

An article in the Focus.news looks at efforts to replicate the hormone oxytocin in the lab – in an effort to develop a painkiller that would be safer than opioids. Read more here: https://www.thefocus.news/lifestyle/scientists-are-hoping-to-replicate-the-cuddle-hormone-for-healthy-long-term-pain-relief/

PNA Spotlight: Dr. Leena Shahla

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.

 

 

 

PNA Highlights October 2024

“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

Featured News and Updates

Research Articles

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)

Copyright © 2024 Pituitary Network Association All rights reserved.

Disclaimer: PNA does not engage in the practice of medicine. It is not a medical authority, nor does it claim to have medical expertise. In all cases, PNA recommends that you consult your own physician regarding any course of treatment or medication.

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P.O. Box 1958
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October 2024 Research Articles

Pituitary Tumors

Investigating the relationship between cognitive impairment and brain white matter tracts using diffusion tensor imaging in patients with prolactinoma.

Duru M, Demir AN, Oz A, Kargin OA, Altunc AT, Demirel O, Arslan S, Kizilkilic O, Poyraz BC, Kadioglu P.J Endocrinol Invest. 2024 Oct 3. doi: 10.1007/s40618-024-02442-y. Online ahead of print.

 

Androgen Receptor Mediates Dopamine Agonist Resistance by Regulating Intracellular reactive oxygen species (ROS) in Prolactin-secreting Pituitary Adenoma.

Xu L, Lei Z, Wang Q, Jiang Q, Xing B, Li X, Guo X, Wang Z, Li S, Huang Y, Lei T.Antioxid Redox Signal. 2024 Oct 3. doi: 10.1089/ars.2024.0611. Online ahead of print.

 

Beyond Epistaxis: A Rare Case of Ectopic Sinonasal Adamantinomatous Craniopharyngioma.

Selva Kumaran K, Shamsudin NS, Dalip Singh HS, Devesahayam PR.Cureus. 2024 Sep 1;16(9):e68357. doi: 10.7759/cureus.68357. eCollection 2024 Sep.


Posterior pituitary tumors and other rare entities involving the pituitary gland.

Roncaroli F, Giannini C.Brain Pathol. 2024 Sep 30:e13307. doi: 10.1111/bpa.13307. Online ahead of print.PMID: 39350562 Review.

 

Pituitary Apoplexy in Pregnancy: Neonatal Implications.

Megan Y, Melissa S.Neoreviews. 2024 Oct 1;25(10):e660-e663. doi: 10.1542/neo.25-10-e660.

 

Giant pituitary macroadenoma with apoplexy presenting with isolated bilateral hypoglossal nerve palsy: illustrative case.

Zaher M, Kolmetzky DW, Al-Atrache Z, Vimawala S, Kolia NR, Godil SS.J Neurosurg Case Lessons. 2024 Sep 30;8(14):CASE24326. doi: 10.3171/CASE24326. Print 2024 Sep 30.

 

Typical Morphological Characteristics of the Immunohistochemistrical Subtypes of Pituitary Microadenomas: A dual center study.

Zhang L, Yan S, Xie SK, Wei YT, Liu HP, Li Y, Wu HB, Wang HL, Xu PF.Endocr Connect. 2024 Sep 1:EC-24-0378. doi: 10.1530/EC-24-0378. Online ahead of print.

 

 

Acromegaly

 

Efficacy and safety of pasireotide treatment in acromegaly: A systematic review and single arm meta-analysis.

Aliyeva T, Muniz J, Soares GM, Firdausa S, Mirza L.Pituitary. 2024 Oct 1. doi: 10.1007/s11102-024-01461-5. Online ahead of print.

 

Cushing’s

 

Frequency of clinical signs in patients with Cushing’s syndrome and mild autonomous cortisol secretion (MACS): Overlap is common.

Braun LT, Vogel F, Nowak E, Rubinstein G, Zopp S, Ritzel K, Beuschlein F, Reincke M.Eur J Endocrinol. 2024 Oct 1:lvae127. doi: 10.1093/ejendo/lvae127. Online ahead of print.

 

 

Pituitary Surgery

 

Stereotactic radiosurgery for recurrent/residual nonfunctioning pituitary adenoma: a single-arm systematic review and meta-analysis.

De Nigris Vasconcellos F, Vilela MAD, Torrico FG, Scalise MA, Vargas VPS, Mendieta CD, Pichardo-Rojas P, Rosi MEA, Fleury LT, de Brito Rebelo ND, Benjamin C, Sheehan JP.Acta Neurochir (Wien). 2024 Oct 2;166(1):392. doi: 10.1007/s00701-024-06296-4.PMID: 39356336 Review.

Editor’s note: Dr. Sheehan is a member of the PNA.

 

Hormonal Health


Prolactin deficiency in the context of other pituitary hormone abnormalities : Special issue: hypoprolactinemia: a neglected endocrine disorder.

Shimon I.Rev Endocr Metab Disord. 2024 Oct 2. doi: 10.1007/s11154-024-09902-z. Online ahead of print.PMID: 39356415 Review.

 

The Ser434Phe Androgen Receptor Gene Mutation Does Not Affect Fertility but is Associated with Increased Prolactin.

Saadeh NA, Obeidat M, Shboul M.Appl Clin Genet. 2024 Sep 26;17:143-149. doi: 10.2147/TACG.S466919. eCollection 2024.

 

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 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.

 

Available Now!

The Pituitary Patient Resource Guide Sixth Edition is now available! Be one of the first to have the most up-to-date information. The Pituitary Patient Resource Guide a one of a kind publication intended as an invaluable source of information not only for patients but also their families, physicians, and all health care providers. It contains information on symptoms, proper testing, how to get a diagnosis, and the treatment options that are available. It also includes Pituitary Network Association's patient resource listings for expert medical care.

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Continuing Education Program

If you are a nurse or medical professional, register for PNA CEU Membership and earn CEU credits to learn about the symptoms, diagnosis and treatment options for patients with pituitary disorders. Help PNA reduce the time it takes for patients to get an accurate diagnosis.

For more information click here!

Seventh Edition - Now Available!

The Pituitary Patient Resource Guide Seventh Edition is now available! Be one of the first to have the most up-to-date information.

The Pituitary Patient Resource Guide a one of a kind publication intended as an invaluable source of information not only for patients but also their families, physicians, and all health care providers.

It contains information on symptoms, proper testing, how to get a diagnosis, and the treatment options that are available. It also includes Pituitary Network Association’s patient resource listings for expert medical care.

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