“Wellness is the complete integration of body, mind, and spirit – the realization that everything we do, think, feel, and believe has an effect on our state of well-being.” – Greg Anderson 

PNA Spotlight: Dr. Pouneh Fazeli

Endocrinologist Dr. Pouneh Fazeli is Chief of the Division of Endocrinology and Metabolism at the University of Pittsburgh School of Medicine.  She did her undergraduate work at Harvard University and earned her medical degree from the University of Pennsylvania. She did a residency and then a chief residency at Columbia University Medical Center, as well as a fellowship in Endocrinology at Massachusetts General Hospital. Dr. Fazeli was kind enough to answer a series of questions from the PNA; her answers follow.

What is your current position?

I am Chief of the Division of Endocrinology and Metabolism at the University of Pittsburgh School of Medicine. I moved to UPMC in 2019 to start the Neuroendocrinology Unit. Together with our outstanding neurosurgical and multidisciplinary teams, we started a Pituitary Center of Excellence.

Please describe your educational journey and mentors

I really fell in love with pituitary physiology and pathophysiology as a medical student at the University of Pennsylvania. I rotated in Dr. Peter Snyder’s clinic, and he is a renowned neuroendocrine pituitary specialist. After seeing patients with him as a third-year medical student, I decided I wanted to become a pituitary endocrinologist. I was a resident in internal medicine and a chief resident at Columbia University Medical Center, where I worked with wonderful endocrinologists, including Drs. Sharon Wardlaw and Pamela Freda.  When I did my fellowship at Mass General Hospital, my primary mentor was Dr. Anne Klibanski. I also worked with outstanding clinical mentors including Drs. Lisa Nachtigall and Beverly Biller.

Read More Here

How Precision Tools Are Improving Pituitary Surgery

Pituitary surgery requires a careful balance: removing the tumor while protecting the normal pituitary gland, optic nerves, carotid arteries and nearby brain structures. Today, Mayo Clinic researchers are helping move the field toward more precise care—guided by better imaging, improved diagnostic tools and real-time support in the operating room.

The goal is straightforward but difficult to achieve: find the tumor more accurately, plan surgery more safely, and personalize care before, during and after treatment.

A clearer map for hard-to-see Cushing tumors

For patients with Cushing disease, precise tumor localization remains one of the greatest challenges. Tumors that produce excess adrenocorticotropic hormone (ACTH) are often extremely small and can be difficult to visualize on standard MRI.

 In this recent study, Mayo Clinic radiologist Dr. Ian Mark, neurosurgeon Dr. Jamie Van Gompel and collaborators evaluated an advanced imaging technology called photon-counting detector CT (PCD-CT). Unlike standard MRI, PCD-CT can capture much finer anatomical detail, allowing clinicians to see tiny structures within the pituitary gland more clearly.

In 25 patients with Cushing disease, PCD-CT localized tumors in 92% of cases, compared with 56% using standard MRI.

For patients, this matters because greater localization may allow surgeons to perform a more targeted operation, rather than having to explore more of the gland. The study does not mean PCD-CT should replace MRI, but rather, it points to an important future role for advanced imaging, especially when MRI can leave uncertainty.

A new perspective on calcified masses

Another facet of precision care involves making the correct diagnosis before surgery. Large sellar or suprasellar masses with calcification—small deposits of calcium that appear as hardened areas on imaging scans—have traditionally raised concern for craniopharyngioma, a rare tumor that develops near the pituitary gland and often requires a different surgical strategy than a pituitary adenoma.

Because calcification is commonly seen in craniopharyngiomas, its presence on imaging has traditionally been considered a hallmark of that diagnosis. However, a recent Mayo Clinic study found that calcification is not exclusive to craniopharyngiomas.

After reviewing 45 pathology-confirmed giant pituitary adenomas, researchers found that 22% contained calcifications. These findings challenge a longstanding assumption and further suggest that calcification alone should not rule out a pituitary adenoma or automatically determine a diagnosis.

For patients, this is another example of precision medicine in action. A more accurate diagnosis helps surgical teams better understand what type of tumor they are treating, consider all appropriate treatment options and develop a care plan tailored to the individual patient.

Using prolactin as a clue before surgery

When considered alongside imaging and other clinical information, blood test results can also help guide a more precise treatment plan.

In a study involving Mayo Clinic researchers, patients with nonfunctioning pituitary adenomas—tumors that do not produce excess hormones—provided a preoperative blood sample.

Among 244 patients, 54% had elevated prolactin levels before surgery. This is often called the “stalk effect.” As a tumor grows, it can put pressure on the pituitary stalk—the connection between the brain and the pituitary gland—disrupting normal hormone signals and causing prolactin levels to rise.

The study suggests that elevated prolactin may serve as an early warning sign that the pituitary gland is already under stress. Patients with higher prolactin levels were also more likely to experience certain hormone deficiencies after surgery, including issues involving thyroid hormone production and the body’s ability to make cortisol, a hormone that helps regulate stress, blood pressure and energy levels.

While elevated prolactin does not guarantee that hormone dysregulation will occur, it may help doctors identify patients who could benefit from closer hormone monitoring and tailored follow-up care after surgery.

Real-time guidance in the operating room

Finally, precision surgery also depends on what happens during the operation itself. In this editorial on intraoperative ultrasound, Drs. Jamie Van Gompel and Hamid Borghei-Razavi discuss renewed interest in using ultrasound during pituitary surgery.

One of the biggest challenges surgeons face is distinguishing tumor tissue from the normal pituitary gland while operating. Although preoperative imaging is essential for planning surgery, anatomy can shift as tumor removal progresses, making those images less reliable in real time.

Intraoperative ultrasound may help bridge that gap by providing surgeons with live imaging during the procedure.

This technology can help identify tumor tissue, look for any remaining tumor and avoid critical brain structures. It may be especially valuable when tumors are difficult to visualize on MRI. Because ultrasound is portable, does not use radiation and can be incorporated directly into the surgical workflow, researchers believe it has the potential to become an important tool for improving surgical precision and safety.

A clearer path forward

Together, these studies show that precision pituitary surgery is not one single technology. It is a broader movement toward improved imaging before surgery, stronger indications from lab tests, and greater guidance in the operating room.

For patients, the message is hopeful but practical: not every tool is right for every case, and several of these approaches still need further validation. But if imaging is unclear, surgery feels complex or follow-up planning is uncertain, it may be worth asking your care team whether advanced imaging, specialized pituitary review or additional endocrine monitoring could be appropriate.

Learn more about pituitary tumor care at Mayo Clinic and explore available diagnostic and treatment options.

PNA Medical Corner: Infection-related Hospitalization and Cushing’s Syndrome

This month the PNA Medical Corner showcases a study coauthored by PNA member Dr. Maria Fleseriu, an

endocrinologist at Oregon Science and Health University. They conclude that patients they studied with Cushing’s Syndrome ended up in the hospital due to infection more than twice as often as people in the control group.

Am J Med 2026 Jun 24:S0002-9343(26)00495-X.

doi: 10.1016/j.amjmed.2026.06.017. Online ahead of print.

Risk of Infection-Related Hospitalization Is More Than Doubled in Cushing’s Syndrome vs Matched Controls

Amit Akirov ¹, Alaa Atamna ², Yaron Rudman ³, Shiri Kushnir ⁴, Tzippy Shochat ⁵, Maria Fleseriu ⁶

Affiliations Expand

PMID: 42342186 DOI: 10.1016/j.amjmed.2026.06.017

Abstract

Background: Cushing’s syndrome is associated with immune dysfunction and increased susceptibility to infection, yet risk of infection-related hospitalization remains unclear. We evaluated infection-related hospitalization in Cushing’s syndrome versus controls.

Methods: Using the Clalit Health Services database, 609 patients with Cushing’s syndrome were identified and matched to 3,018 controls by age, sex, socioeconomic status, and body mass index. The primary outcome was infection-related hospitalization. Competing-risk models were used with death as a competing event. Analyses were performed according to etiology, remission, and infection subtype.

Results: During mean follow-up of 13.4 years in patients with Cushing’s syndrome and 13.9 years in controls, infection-related hospitalization occurred in 14.1% vs 5.9% (86/609 vs 178/3,018), with incidence rates of 10.5 vs 4.2 per 1,000 person-years. Patients with Cushing’s syndrome had a higher risk of infection-related hospitalization (HR 2.5, 95% CI 1.9-3.2), observed in both Cushing’s disease (HR 3.8, 95% CI 2.5-5.7) and adrenal disease (HR 2.3, 95% CI 1.5-3.6). Respiratory and genitourinary infections were the most common causes, and opportunistic infections were more frequent in Cushing’s syndrome (12.5% vs 5.6%, p=0.04). Patients in remission remained at increased risk (HR 2.5, 95% CI 1.6-3.8), while older age and higher body mass index independently predicted hospitalization, with most infections occurring in patients aged ≥55 years and body mass index ≥25 kg/m².

Conclusion: Patients with Cushing’s syndrome have an excess risk of infection-related hospitalization affecting both common and opportunistic infections and risk persists after remission. These findings support ongoing infection surveillance and preventive measures.

Keywords: Cushing’s Syndrome; Hospitalization; Infection; Pituitary.

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.”

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)