News Articles February 2022
Written on 04 February 2022.
PNA Spotlight: Dr. Adam Mamelak
This month the PNA Spotlight focuses on Dr. Adam Mamelak, a neurosurgeon and co-director of the Pituitary Center at Cedars Sinai Medical Center in Los Angeles. Dr. Mamelak earned his B.A. in Physics at Tufts University and earned his MD from Harvard Medical School. He did a surgical internship and then a residency at the University of California at San Francisco Medical Center. He did a fellowship at the Epilepsy Research Laboratory at UCSF, and another postdoctoral fellowship in neuroscience at the California Institute of Technology & Huntington Medical Research Institutes in Pasadena, California. Dr. Mamelak was kind enough to answer a series of questions from the PNA.
His answers follow.
• What inspired you to choose your career path?
I was inspired to become a neurosurgeon based on a sincere desire to understand how the brain works, combined with the need to have an impactful role in the care of patients. As I looked at various career paths in medicine, only neurosurgery seem to fulfill that twin desire. Once I began working as a neurosurgeon, I was drawn to the field of pituitary tumors, both out of a fascination with the complex interplay between the brain, bodily hormones, and overall health, as well as a fascination with the surgical methods that are unique to this area of neurosurgery. Fortunately, my inspiration has proved to be entirely correct. In my practice I can treat patients with complex diseases in a hands-on way. But at the same time, I have the opportunity to advance the field forward through research clinical trials and other interactions.
• What is the primary focus of your work/research?
The primary focus of my work is in developing fluorescent markers to detect tumors intraoperatively. I have helped to develop an imaging system that relies on a protein derived from scorpion venom which, when attached to a near-infrared dye, is taken up by tumors and literally turns them fluorescent during surgery. This allows surgeons to get safer and more complete removal of the tumor while avoiding injury to the surrounding structures such as the pituitary gland or stalk. I have also done substantial work in the development of surgical techniques for the removal of pituitary masses.
• What do you consider to be the future of your field?
In my opinion, the future of our field will see the progressive elimination of the need for surgery. The development of medical therapies will shrink or eliminate tumors and correct hormonal imbalances without the need to operate. Furthermore, the development of stem cell transplants that can regenerate pituitary function is an exciting new horizon. Much like the transplantation of pancreatic cells for patients with insulin-dependent diabetes, there is hope that stem cells from the pituitary gland can be transplanted to regenerate normal hormone production after tumors or other treatments lead to their loss.
• What should patients know about your field/what deserves more recognition/awareness?
The most critical thing for patients to know about the field of pituitary disorders and pituitary tumors in general is that even though these tumors are very common, the typical neurosurgeon treats very few of them in a given year. Patients may be surprised to know that the average neurosurgeon in a busy clinical practice performs no more than 1-3 pituitary operations in a year! Substantial data demonstrates that surgeons who perform at least 30-50 pituitary surgeries a year have much better and safer outcomes. This impact is further realized for more complex situations such as craniopharyngiomas and meningiomas, where only surgeons with significant experience in endoscopic methods will be able to remove these growths safely. Patients should be aware that they should seek out expert providers before any surgery is undertaken, not after the fact. This is under-recognized. This concern must also be more recognized by insurers, as expert and efficient pituitary surgical care results in lower costs to them as well.
• What would you like to convey about yourself to your patients?
I would like my patients to know that I am completely dedicated to their care. My primary focus is figuring out what is the best individual solution for a specific patient. For some patients, surgery is appropriate. And for many others, observation alone or medical treatment is the correct solution. Even though I am a surgeon, I am by no means biased toward surgery. In fact, I tend to take a conservative approach in many situations. However, once surgery is appropriate, my expertise and experience – as well as the comprehensive care available through the pituitary program at Cedars Sinai – will help ensure a smooth and optimal outcome.
• Why did you get involved with the PNA; what is the extent of your involvement?
My involvement with the PNA is to provide a resource and become a patient advocate. PNA does a great job in making patients aware of the signs and symptoms of pituitary disease as well as treatment options to maximize care. It provides a great resource for helping patients navigate the complex health care system. As a physician and patient advocate, I primarily serve as a reference point for patients seeking information or for outside groups seeking expert consultation.
PNA Medical Corner: Proposed Clinical Classification of Pituitary Neoplasms
This month the PNA Medical Corner features an article co-authored by multiple members of the PNA: Drs. Ho, Fleseriu, Little, Kaiser, and Melmed. It proposes a new standard for clinical classification for pituitary neoplasms.
A proposed clinical classification for pituitary neoplasms to guide therapy and prognosis
- PMID: 38301678 DOI: 10.1016/S2213-8587(23)00382-0
Abstract
No comprehensive classification system that guides prognosis and therapy of pituitary adenomas exists. The 2022 WHO histopathology-based classification system can only be applied to lesions that are resected, which represent few clinically significant pituitary adenomas. Many factors independent of histopathology provide mechanistic insight into causation and influence prognosis and treatment of pituitary adenomas. We propose a new approach to guide prognosis and therapy of pituitary adenomas by integrating clinical, genetic, biochemical, radiological, pathological, and molecular information for all adenomas arising from anterior pituitary cell lineages. The system uses an evidence-based scoring of risk factors to yield a cumulative score that reflects disease severity and can be used at the bedside to guide pituitary adenoma management. Once validated in prospective studies, this simple manageable classification system could provide a standardised platform for assessing disease severity, prognosis, and effects of therapy on pituitary adenomas.
News Articles February 2024
Touch Endo Newsletter
The latest newsletter from Touch Endo covers a range of topics, including research on diagnosing pituitary tumors, treating diabetes, lessening symptoms of menopause, and promoting liver health. Read more here:
Banned Growth Hormone Linked to Transmission of Alzheimer’s
A study published in the Journal Nature looks at the prevalence of Alzheimer’s disease in patients injected with cadaver-derived pituitary growth hormone, which was banned in 1985 after some patients developed Creuztfeldt-Jakob disease. It is the first documentation of the transmissibility of Alzheimer’s Read more here:
Here is an article that explains why this is unlikely to happen again. Read more here:
U.K. Soccer Player Battles Acromegaly
An article in the Leicester Mercury tells the story of Tom Mayor, a semi-pro goalkeeper diagnosed with acromegaly. Read more here:
Can A-I Help Write Medical Case Reports?
An article in on Cureus.com presents a case study of a child with Rathke’s Cleft Cyst, written using artificial intelligence, in this case ChatGPT. The author concludes that ChatGPT produced some helpful tables, it “has limitations in answering questions, particularly in providing specific data and addressing individual cases.” Read more here:
February 2024 Research Articles
Pituitary Tumors
Functional gonadotroph pituitary adenoma: A case report.
Prolactinoma and Adenomyosis – More than Meets the Eye: A Case Report.
Brain tumor detection from images and comparison with transfer learning methods and 3-layer CNN.
Clinical and Pathological Features of Pit1/SF1 Multilineage Pituitary Neuroendocrine Tumor.
Pituitary Surgery
Cushings
Panhypopituitarism
Pituitary Abscess Causing Panhypopituitarism in a Patient With Neurobrucellosis: Case Report.
Pituitary Hypophysitis
Pituitary hypophysitis in granulomatosis with polyangiitis (GPA): a case series.
Pituitary Cancer
Hepatocellular carcinoma metastatic to the pituitary gland without an identifiable primary lesion.
Hormonal Health
The adverse role of endocrine disrupting chemicals in the reproductive system.
PNA Highlights January 2024
“Give a man health and a course to steer, and he’ll never stop to trouble about whether he’s happy or not.”
– George Bernard Shaw
PNA Spotlight: Dr. Paul A. Gardner
This month the PNA Spotlight focuses on Dr. Paul A. Gardner.
Paul A. Gardner, MD, joined the faculty at the University of Pittsburgh Department of Neurological Surgery in 2008 after completing his residency and fellowship training at the University of Pittsburgh. He completed his undergraduate studies at Florida State University, majoring in biochemistry, and received his medical degree from the University of Pittsburgh School of Medicine.
Dr. Gardner completed a two-year fellowship in endoscopic endonasal pituitary and endoscopic and open skull base surgery. His research has focused on evaluating patient outcomes following these surgeries and more recently on genomic and molecular analysis of skull base tumors. Dr. Gardner has been the neurosurgical director of the Center for Cranial Base Surgery at the University of Pittsburgh Medical Center since April of 2008 and, along with Carl Snyderman, MD, of the University of Pittsburgh Department of Ophthalmology, leads a renowned course on endoscopic endonasal surgery three times a year.
His answers are below:
PNA Medical Corner: Artificial intelligence and pituitary surgery
The PNA Medical Corner this month features an article co-authored by neurosurgeon Aaron Cohen-Gadol of Indiana University, a longtime member of the PNA. They conclude that A-I and machine learning will improve preoperative planning and surgical strategies in pituitary surgery, but points out challenges on multiple fronts.
Current status of artificial intelligence technologies in pituitary adenoma surgery: a scoping review
- PMID: 38183582 DOI: 10.1007/s11102-023-01369-6
Abstract
Purpose: Pituitary adenoma surgery is a complex procedure due to critical adjacent neurovascular structures, variations in size and extensions of the lesions, and potential hormonal imbalances. The integration of artificial intelligence (AI) and machine learning (ML) has demonstrated considerable potential in assisting neurosurgeons in decision-making, optimizing surgical outcomes, and providing real-time feedback.
The FDA has approved NGENLA (somatrogon-ghla)
The FDA has approved NGENLA (somatrogon-ghla), a once-weekly, human growth hormone analog indicated for treatment of pediatric patients aged three years and older who have growth failure due to an inadequate secretion of endogenous growth hormone.
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]
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PNA Spotlight: Dr. Paul Gardner
This month the PNA Spotlight focuses on Dr. Paul A. Gardner.
Paul A. Gardner, MD, joined the faculty at the University of Pittsburgh Department of Neurological Surgery in 2008 after completing his residency and fellowship training at the University of Pittsburgh. He completed his undergraduate studies at Florida State University, majoring in biochemistry, and received his medical degree from the University of Pittsburgh School of Medicine.
Dr. Gardner completed a two-year fellowship in endoscopic endonasal pituitary and endoscopic and open skull base surgery. His research has focused on evaluating patient outcomes following these surgeries and more recently on genomic and molecular analysis of skull base tumors. Dr. Gardner has been the neurosurgical director of the Center for Cranial Base Surgery at the University of Pittsburgh Medical Center since April of 2008 and, along with Carl Snyderman, MD, of the University of Pittsburgh Department of Ophthalmology, leads a renowned course on endoscopic endonasal surgery three times a year.
His answers follow.
• What inspired you to choose your career path?
The variety of deeply impactful effects of pituitary tumors as well as the intricate anatomy around the pituitary.
• What is the primary focus of your work/research?
Patient outcomes including quality of life; genetic research into the sources of tumors as well as differences between different tumor types; impact of surgery of patients
• What do you consider to be the future of your field?
Refining surgical techniques to lessen impact on patients and understanding the genetics of tumors to provide other treatment options
• What should patients know about your field/what deserves more recognition/awareness?
Pituitary surgery is borne out of practice by multidisciplinary teams of ENT and neurosurgery. This kind of collaboration is not common in medicine but leads to better outcomes and even new approaches.
• What would you like to convey about yourself to your patients?
I do my best to understand every person’s story. This helps me apply the knowledge and experience that I have attained over 20 years in practice to that individual to help them best achieve their health goals. This shared decision making allows me to honestly apply my treatments to the utmost of my ability in line with their wishes.
• Why did you get involved with the PNA; what is the extent of your involvement?
I originally became involved after sitting in on a patient support group. I was very impressed with the PNA leadership and passion and inspired to further my work and research with pituitary and similar tumors. I have been involved in the PNA ever since, largely with lectures and promotional support with my and others’ patients.
PNA Medical Corner: Artificial Intelligence and Pituitary Surgery
The PNA Medical Corner this month features an article co-authored by neurosurgeon Aaron Cohen-Gadol of Indiana University, a longtime member of the PNA. They conclude that A-I and machine learning will improve preoperative planning and surgical strategies in pituitary surgery, but points out challenges on multiple fronts
Current status of artificial intelligence technologies in pituitary adenoma surgery: a scoping review
- PMID: 38183582 DOI: 10.1007/s11102-023-01369-6
Abstract
Purpose: Pituitary adenoma surgery is a complex procedure due to critical adjacent neurovascular structures, variations in size and extensions of the lesions, and potential hormonal imbalances. The integration of artificial intelligence (AI) and machine learning (ML) has demonstrated considerable potential in assisting neurosurgeons in decision-making, optimizing surgical outcomes, and providing real-time feedback. This scoping review comprehensively summarizes the current status of AI/ML technologies in pituitary adenoma surgery, highlighting their strengths and limitations.
Methods: PubMed, Embase, Web of Science, and Scopus were searched following the PRISMA-ScR guidelines. Studies discussing the use of AI/ML in pituitary adenoma surgery were included. Eligible studies were grouped to analyze the different outcomes of interest of current AI/ML technologies.
Results: Among the 2438 identified articles, 44 studies met the inclusion criteria, with a total of seventeen different algorithms utilized across all studies. Studies were divided into two groups based on their input type: clinicopathological and imaging input. The four main outcome variables evaluated in the studies included: outcome (remission, recurrence or progression, gross-total resection, vision improvement, and hormonal recovery), complications (CSF leak, readmission, hyponatremia, and hypopituitarism), cost, and adenoma-related factors (aggressiveness, consistency, and Ki-67 labeling) prediction. Three studies focusing on workflow analysis and real-time navigation were discussed separately.
Conclusion: AI/ML modeling holds promise for improving pituitary adenoma surgery by enhancing preoperative planning and optimizing surgical strategies. However, addressing challenges such as algorithm selection, performance evaluation, data heterogeneity, and ethics is essential to establish robust and reliable ML models that can revolutionize neurosurgical practice and benefit patients.
News Articles January 2024
Woman diagnosed with pituitary tumor after nose, feet grow
A woman in the U.K. ignored her fatigue and headaches for years, but saw a doctor after her nose and feet kept getting bigger. That led to the discovery of a pituitary tumor that had been present for 20 years. Read more here:
Pituitary history: the man who grew from 4’ to 7’8”
An article on the site Boing Boing explores the case of Adam Rainer, an Austrian man born in 1899 whose acromegaly caused him to start out at the unusually small adult height of 4 feet tall – and then grow to a height of 7’8”. He underwent surgery but sadly passed away at age 51. Read more here:
Research links oxytocin to sex addiction
A study done by researchers in Cypress and Sweden found high oxytocin levels in men suffering from hypersexual disorder. Read more here:
Study looks at link between neurological complications and obesity
Researchers are looking into a case study where severe obesity may have set the stage for intracranial pressure, which may have caused neurological conditions such as flattened posterior globes and an empty sella. Read more here:
Can the covid vaccine lead to pituitary enlargement? A case study.
An article in Cureus looks at a case study of a woman whose pituitary enlarged after she received a fourth Covid-19 vaccine. Read more here:
January 2024 Research Articles
Pituitary Tumors
Prognostic Biomarkers in Pituitary Tumours: A Systematic Review.
Enhanced EPR effects by tumour stromal cell mimicking nanoplatform on invasive pituitary adenoma.
Double Pituitary Incidentaloma in a Young Woman With Sinusitis-Related Headache.
Complete Binasal Hemianopia-Associated With Pituitary Microadenoma or Idiopathic?-A Case Report.
Pituitary Surgery
Cushings
Hormonal Health
Endocrine Hypertension: The Urgent Need for Greater Global Awareness.
Central precocious puberty: assessment, diagnosis and decisions about treatment.
Multiple sclerosis and hypogonadism: is there a relationship?
Endocrine Disruptors and Metabolic Changes: Impact on Puberty Control.
PNA Highlights December 2023
“He who has health has hope; and he who has hope, has everything.” – Thomas Carlyle
PNA Spotlight: Dr. Juan Fernandez-Miranda
This month the PNA Spotlight focuses on Dr. Juan Carlos Fernandez-Miranda, a Professor of Neurosurgery and the Surgical Director of Brain Tumor, Skull Base and Pituitary Centers at Stanford University. Dr. Fernandez-Miranda did a neurosurgery residency at La Paz University Hospital in Madrid, Spain. He completed a fellowship in microsurgical neuroanatomy at the University of Florida. He did clinical training in cerebrovascular surgery at the University of Virginia, and in endoscopic endonasal and open skull base surgery at University of Pittsburgh Medical Center (UPMC). He joined the faculty at Stanford earlier this year. He was kind enough to answer some questions from the PNA. His answers are below:
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)
PNA Medical Corner: Cushing Disease and Double Pituitary Adenoma
This month in the PNA Medical Corner we focus on a study coauthored by two members of the PNA: Drs. Adriana Ioachimescu and Nathan Zwagerman. The research is a case study of a woman with two pituitary tumors.
Consecutive resections of double pituitary adenoma for resolution of Cushing disease: illustrative case
Featured News and Updates
The FDA has approved NGENLA (somatrogon-ghla)
The FDA has approved NGENLA (somatrogon-ghla), a once-weekly, human growth hormone analog indicated for treatment of pediatric patients aged three years and older who have growth failure due to an inadequate secretion of endogenous growth hormone.
Research Articles
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.
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