​“What mental health needs are more sunlight, more candor, and more unashamed conversation.” – Glenn Close

PNA Spotlight: Georgios A. Zenonos, MD FAANS

Georgios A. Zenonos is the Neurosurgical Director of the Center for Cranial Base Surgery, Pituitary Center of Excellence, and Center for Cranial Nerve Disorders at the University of Pittsburgh Medical Center Neurological Institute. Dr. Zenonos received his medical degree from the National and Kapodistrian University of Athens School of Medicine. 

He undertook post-doctoral research fellowships at Harvard Medical School in 2010 and at the University of Pittsburgh in 2011. He stayed on and completed his seven-year neurological surgery residency training, as well as an enfolded fellowship in endoscopic and open skull base surgery at the University of Pittsburgh School of Medicine.  He then went on to complete a fellowship in skull base and cerebrovascular surgery at the University of Miami. Dr. Zenonos was kind enough to answer some questions from the PNA. His answers follow.

Please tell us why you chose to specialize in neurosurgery?

I was always intrigued by our nervous system and the brain in particular; they are sort of what makes us who we are. Even in medical school, one of the things that interested me the most was learning about brain and its functions. The surgical specialties were more appealing to me, because you can make a big difference for a patient. It seemed like we were almost preparing to go to war, where it was you and the patient against the disease. It was more physical, and direct way to help patients. In surgery, there is no hiding. The effects of everything you do are so immediate and direct, so it’s quite more gratifying.

Tell us about your early education:

I grew up in Cyprus. Everyone there must do military service after high school. I completed a 26-month period of military service, where I served as a military officer, and then went straight to medical school at the National and Kapodistrian University of Athens. Medical school in Athens is a six-year program.

I then completed a post-doctoral research fellowship in Boston at Harvard Medical School, and then moved to Pittsburgh for my residency, as well as a skull base fellowship, focusing both on endoscopic approaches and open approaches. I then moved to Miami for one year for an additional fellowship in cerebrovascular and skull base surgery. I moved back to Pittsburgh to join the faculty in 2019. 

Read More Here

Why Teamwork Matters in Pituitary Tumor Care

A pituitary tumor diagnosis often raises immediate concerns for patients, but according to Mayo Clinic endocrinologist Dr. Susan Samson and neurosurgeon Dr. Kaisorn Chaichana, one of the biggest advantages patients can have is a coordinated team guiding every step of their care.

For Dr. Samson, that process begins with reassurance. “The vast majority of these are very benign,” she says. “Patients have an impression they have a brain tumor, and that can cause them extreme anxiety.” From there, the team’s focus shifts to answering two essential questions: Is the tumor affecting hormone production? And is it large enough to threaten nearby structures such as the optic nerves?

That evaluation begins with close collaboration between endocrinology and neurosurgery.

“We really work as a team here,” Dr. Chaichana says. “Dr. Samson does a lot of the workup for our patients with pituitary tumors. If she thinks they need surgery, then she sends them to me. Sometimes I get the patient first, but typically we’re hand in hand 99 out of 100 times. That’s a good reason why we work as a team. We usually come to an agreement on the best approach.”

For Dr. Samson, that partnership extends well beyond making a diagnosis. She has helped develop standardized perioperative protocols that bring together endocrinologists, neurosurgeons, intensive care teams, and nursing staff before every pituitary operation. The goal is to reduce complications, minimize unnecessary steroid use, prevent postoperative hyponatremia, and safely manage patients after they return home.

“One of the things that I brought with me was a really protocolized approach to how we think about a patient perioperatively,” she says. “How do we align how we manage these patients?” She notes that careful coordination has helped reduce complications and prevent hospital readmissions while allowing many patients to recover safely outside the hospital.

Treatment decisions themselves are rarely made by one specialty alone.

“It’s not really clear cut all the time,” Dr. Chaichana says. “That’s why we converse a lot about each of these patients, and we often see patients on the same day or in the same room together to go over that plan.” For nonfunctioning tumors, observation may be appropriate unless the tumor is growing or threatening vision. Functional tumors that produce excess hormones often require surgery, while prolactin-producing tumors are frequently treated with medication first.

Mayo’s multidisciplinary philosophy also changes the patient experience. Rather than seeing specialists one after another over multiple appointments, patients often meet with the entire team during a single visit.

“If the patient comes in at 9:30, they’ll see all of us in the same room at the same time,” Dr. Chaichana says. “We expedite care that way.” He adds that patients benefit from “a team approach,” faster decision-making, and having questions answered immediately instead of waiting for separate appointments.

Dr. Samson believes patients should actively seek out that level of expertise.

“I would really recommend they go to a high-volume pituitary center of excellence,” she says. “Find the right doctor and the right team for you.”

Together, their perspectives reflect a simple philosophy: pituitary tumors may involve complex hormonal, neurological and surgical issues, but when experienced specialists work together from the very beginning, patients receive coordinated care designed to improve outcomes, reduce complications and provide confidence throughout treatment.

PNA Medical Corner: Virtual Dissection Environments

This month the PNA Medical Corner focuses on a study co-authored by Juan Carlos Fernandez-Miranda at Stanford University, a longtime member of the PNA. The study looks at the merits of virtual reality programs that teach the anatomy involved in the endoscopic endonasal approach.

J Neurosurg

. 2026 Jul 31:1-12.

 doi: 10.3171/2026.2.JNS252684. Online ahead of print.

Development and evaluation of a virtual dissection environment for anatomical learning in the endoscopic endonasal approach

Tatsuya Uchida ^1 2, Yuanzhi Xu ¹, Taichi Kin ^2 3, Vera Vigo ¹, Yuhei Sangatsuda ¹, Erik Burgos-Sosa ¹, Masaki Ikegami ¹, Aaron A Cohen-Gadol ⁴, Nobuhito Saito ², Juan Carlos Fernandez-Miranda ¹

Affiliations Expand

• PMID: 42537235  DOI: 10.3171/2026.2.JNS252684

Abstract

Objective: A clear 3D understanding of complex skull base structures, including the cavernous sinus (CS), is vital for the endoscopic endonasal approach. However, traditional learning (TL) methods using textbooks and static materials have limits in fostering spatial comprehension. This study developed an interactive virtual dissection (VD) environment based on a virtual endoscopic skull base anatomy 3D computer graphics (VESA-3DCG) model to enhance 3D understanding of the sellar and parasellar regions and evaluated its educational effectiveness against TL methods.

Methods: The VESA-3DCG model was constructed by modifying previously developed high-fidelity 3DCG models, which were designed with reference to the authors’ previous anatomical studies of the sellar and parasellar regions, and integrated into a VD environment. Twenty-eight Japanese neurosurgical residents (postgraduate years 3-7) were randomly assigned to the VD or TL group. Both learning sessions were conducted remotely via a screen-sharing platform, allowing participants to view and interact with the presented materials in real time. A knowledge test covering four domains-bony landmarks, CS anatomy, microvascular anatomy, and neural anatomy-was administered before and after learning. Gain scores, defined as pre- to posttest improvement, were calculated per domain and overall. Group comparisons were performed to assess learning outcomes, and satisfaction and confidence were rated on a 5-point Likert scale.

Results: The final model, consisting of 304 components and about 18.6 million polygons, accurately depicted the microanatomy of the sellar and parasellar regions. The VD environment supported interactive manipulation, including transparency and translucency control, rotation, zooming, virtual drilling, and retraction. Gain score analysis showed that the VD group achieved greater overall improvement in anatomical learning relative to the TL group (p = 0.036), with the most robust difference observed in the CS anatomy domain (p = 0.001). Within-group analysis in the VD group confirmed notable posttest gains in bony landmarks, CS anatomy, and neural anatomy. Participants reported high satisfaction and confidence with the VD environment.

Conclusions: The VD environment based on the VESA-3DCG model offered an effective, interactive platform for anatomical learning. It demonstrated favorable educational effects, particularly for anatomically complex regions such as the CS, and showed feasibility as a complementary tool to TL, including in remote education settings.

Keywords: anatomy; cavernous sinus; endoscopic endonasal approach; neurosurgical education; pituitary surgery; skull base; surgical neuroanatomy; three-dimensional computer graphics; virtual dissection.

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)