Keep your vitality. A life without health is like a river without water.” – Maxime Lagacé 

PNA Spotlight: Dr. Fredric B. Meyer

This month the PNA Spotlight focuses on Fredric B. Meyer, M.D., a consultant and professor of neurologic surgery and enterprise chair of the Department of Neurologic Surgery at Mayo Clinic in Rochester, Minnesota.  He holds the Alfred Uihlein Family Professorship of Neurologic Surgery. He is also the Juanita Kious Waugh Executive Dean of Education of the Mayo Clinic College of Medicine and Science, and Dean of the Mayo Clinic Alix School of Medicine.  He studied biology at the University of Pennsylvania, earned his MD at Boston University, and completed residency and fellowship in neurologic surgery at the Mayo Clinic School of Graduate Medical Education, which is part of Mayo Clinic College of Medicine.  He was kind enough to answer questions from the PNA; his answers follow.

Tell me about your educational journey.

I went to college at University of Pennsylvania and then to medical school at Boston University. I completed seven years of neurological surgery training at Mayo Clinic along with several fellowships before staying on staff at Mayo. I trained with Dr. Edward Laws, who taught me much about skull base and pituitary surgery.

Read More Here

PNA Medical Corner: Dopamine-2 and prolactinomas

   This month the PNA Medical Corner features a study coauthored by a member of the PNA, Dr. Kalmon Post, a neurosurgeon at Mount Sinai Hospital in New York. The study looks at dopamine-2 receptor expression in prolactinomas and has implications on the wisdom of continuing dopamine agonist therapy in some patients.

J Clin Med . 2025 Oct 17;14(20):7344.

doi: 10.3390/jcm14207344.

Immunohistochemical Comparison of Dopamine-2 Receptor Expression in Resistant and Non-Resistant Prolactinomas

Ilana Ramer Bass ¹, Julia Ferreira de Carvalho ¹, Melissa Umphlett ², William Shuman ³, Alexander Kirschenbaum ⁴, Emily Milgrim ¹, Lucas Milgrim ¹, Joshua Bederson ³, Kalmon Post ³, Raj Shrivastava ³, Alice C Levine ¹

Affiliations Expand

• PMID: 41156214  DOI: 10.3390/jcm14207344

Abstract

Background: Dopamine agonists (DAs) are first-line therapy for prolactin-secreting pituitary adenomas; however, a small proportion of tumors are resistant. Previous reports suggested that reduced D2R mRNA expression might cause resistance. This study aimed to determine if resistant prolactinomas express D2R protein. We also explored a role of estrogen receptor alpha (ERα) expression in DA resistance. Methods: We retrospectively selected 15 tumor specimens from 13 total patients (8 controls from 8 patients, 7 from 5 resistant patients) with resected lactotroph cell-type tumors. We reviewed age at diagnosis, tumor size, initial prolactin level, medical treatment, and reason for surgery. Immunohistochemistry was performed for D2R, prolactin, and ERα protein expression. Results: D2R expression was positive in seven of eight controls vs. two of seven in resistant tumors (p = 0.02). ERα expression did not significantly correlate with DA resistance. The two D2R expressing resistant tumors were ERα negative and both derived from a pre-pubertal female, supporting prior reports suggesting ERα may modulate DA therapy response. Conclusions: Our study introduces a reproducible method for assessing D2R protein expression in prolactinomas using commercially available D2R antibodies. Our findings align with current evidence indicating that lack of D2R expression, previously indicated by decreased mRNA levels, is common in DA-resistant prolactinomas and provide a basis for discontinuation of DA therapy to avoid potential harm to these patients.

Keywords: D2 receptors; dopamine agonist; prolactinoma; resistance.

Patient story: Panhypopit patient in a bind as Humatrope is discontinued

Tara Cummins, a pituitary patient in Klamath Falls, Oregon, says she’s at her wits’ end because the medication she depends on, Humatrope, is being discontinued by pharmaceutical giant Eli Lilly. Humatrope is Lilly’s version of somatropin, used to keep people like Cummins alive. Cummins suffers from panhypopituitarism, which developed after pituitary failure soon after a hysterectomy done in 1992 to counter painful recurring ovarian cysts.  She also experienced pituitary failure.

Cummins has no health insurance because she makes too much to qualify for Medicaid and cannot afford to buy insurance on the individual market.  In addition, when she had insurance, it didn’t cover the medication she needed. She sued the insurance company, saying, “Policies are allowed to be changed and modified to under-cover conditions or medications or exclude treatment for certain conditions.  Early on after my settlement with the insurance company (where I still maintained my policy) they changed the terms of the policy, leaving me with a choice of having insurance but not coverage (or adequate coverage) for the somatropin which left me with out-of-pocket expenses that almost no one would be able to afford. With no insurance, I could qualify for patient assistance directly through the manufacturer. The term used was being under insured; as if I had any option to be more insured.”

So, Cummins has been paying for doctor visits on her own and she relies on Eli Lilly’s patient assistance program for free access to her medication: 1 mg each night.  At age 63, it’ll be a little more than a year before the retiree qualifies for Medicare. In the past, she took Pfizer’s version of the medication, Genatropin, but Pfizer discontinued its patient assistance program two years ago, and the medication costs between $5,800 and $16,000 a month if you don’t have insurance.

Cummins says she hopes to get one more shipment from Eli Lilly, which would last her about four months.  She says she’s been told that her life expectancy without the medication is about two years.

Complicating matters, Novo Nordisk’s Norditropin Flexpro subcutaneous solution for injection, is on shortage as of September. On ashp.com, the shortage is attributed “to increased demand and manufacturing delays.”  The site notes that Ferring has Zomacton available; that Genentech discontinued Nutropin AQ Nuspin presentations in December 2024; that Pfizer has Genotropin available (but discontinued the patient assistance program); and that Sandoz has Omnitrope available.

In addition, Cummins had her thyroid removed and relies on natural thyroid medication.  However, the FDA announced in August that it wants animal-derived thyroid medications off the market because they are not FDA approved and “contain many compounds that are uncharacterized for safety and effectiveness.”  The FDA estimates that “1.5 million patients received prescriptions for these medications from U.S. outpatient retail pharmacies in 2024.”

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)