News Articles February 2022
Written on 04 February 2022.
PNA Spotlight: Dr. Adriana G. Ioachimescu
This month the PNA Spotlight focuses on Adriana G. Ioachimescu, MD, PhD, FACE Professor of Medicine (Division of Endocrinology and Molecular Medicine) and Neurosurgery at the Medical College of Wisconsin, a lifetime professional member of the PNA.
Dr. Ioachimescu was a Professor of Medicine in Endocrinology and Neurosurgery at the Emory University School of Medicine. Dr. Ioachimescu was also co-director and co-founder of the Emory Neuroendocrine Pituitary Center and a consulting editor at Endocrinology and Metabolism Clinics. Previously she worked at Carol Davila University in Bucharest, Romania, and at the Cleveland Clinic.
Dr. Ioachimescu was born in Bucharest, Romania and earned her PhD in Neuroendocrinology from Carol Davila University of Medicine. She completed an internship in internal medicine at Danbury Hospital and then a fellowship in Endocrinology at the Cleveland Clinic. She did residencies in internal medicine at Carol Davila University, Yale University and the Cleveland Clinic.
Dr. Ioachimescu was kind enough to respond to a few questions from the PNA:
What inspired you to choose your career path?
In medical school, I had a wonderful professor of endocrinology, Dr. Mihai Coculescu, who inspired me to follow this path. Endocrinology was a great fit for me because I loved biochemistry and math. I became fascinated by feedback loops and hormonal circadian rhythms. I noticed the how hormones disturbances influence many organs and systems, especially in patients with pituitary tumors. I was captivated by the link between hormones and the brain and started research in this field early on in my medical career.
What is the primary focus of your work/research?
I am a pituitary endocrinology specialist, which means I see patients with disorders of the pituitary gland, as well as adrenal disorders that cause high cortisol levels., In terms of research, one of my current interests is to establish prognostication systems for pituitary adenomas, which will allow personalized treatments. Let’s take acromegaly, for example. When I saw my first patient with this condition 25 years ago in Romania, all we had in terms of medical treatment was bromocriptine. We now have available several classes of medications that we use based on a “trial and error” approach. I hope research will move us closer to customized treatment plans that get our patients in control and feeling better faster.
What do you consider to be the future of your field?
These are exciting times for specialists like me who dedicated their career to the pituitary gland. Several histological and molecular markers have been developed that have allowed us to move translational research closer to the patients and their problems. Physicians will soon have the right tools to predict clinical course of pituitary adenomas more precisely and to develop individualized plans to manage them. Also, scientists are working on treatments that specifically target certain genetic or molecular pathways that will create a paradigm shift in how we treat pituitary disorders.
What should patients know about your field/what deserves more recognition or awareness?
Pituitary disorders are complex and usually require a multidisciplinary approach. Every day, I am in contact with neurosurgeons, neuroradiologists, pathologists, radiation oncologists, gynecologists, urologists, psychologists and other specialists. Most importantly, I constantly communicate with the internists or primary care physicians. While the hormones and/or the tumor itself are at the center of the problem, they cause diverse health problems that warrant specific evaluation and management.
What would you like to convey about yourself to your patients?
It is a privilege for me to take care of you. I am honored by the trust you place in me and I will continue to work tirelessly to help you feel better. I know that the same condition affects different patients in different ways and that laboratory results can be confusing. I realize the complexity of your condition. I learn something new every day. I assure you, we make progress in our diagnostic and therapeutic abilities. I am here to guide you through the process and offer you a treatment plan that suits your needs.
Why did you get involved with the PNA and what is the extent of your involvement?
I like working with the PNA because this organization offers a reliable source of information for patients and their families. The PNA has provided valuable patient advocacy in the field of pituitary diseases since 1992. I partnered with PNA thirteen years ago because we share the goals of improving awareness about pituitary disorders and educating both patients and the medical community. I am a member of the PNA scientific advisory board and together we published books and other educational materials, and we recorded webinars. The PNA staff is friendly and passionate about their mission.
April 2023 Research Articles
Pituitary Tumors
Fatigue and Its Contributing Factors in Chinese Patients with Primary Pituitary Adenomas.
Novel imaging techniques in refractory pituitary adenomas.
Radiotherapy in aggressive or dopamine agonists resistant prolactinomas; is it still worthwhile?
Approach to the Patient with Prolactinoma.
Editor’s note: Dr. Colao is a member of the PNA.
Pituitary Surgery
Rhinologic outcome of endoscopic transnasal-transsphenoidal pituitary surgery: an institutional series, systematic review, and meta-analysis.
Pituitary Abnormalities
Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET).
Pituitary Enlargement and Hypopituitarism in Patients Treated with Immune Checkpoint Inhibitors: Two Sides of the Same Coin?
Pituitary Abscess: A Challenging Preoperative Diagnosis-A Multicenter Study.
Acromegaly
Cognitive Dysfunction, an Increasingly Valued Long-Term Impairment in Acromegaly.
Caloric restriction as a possible pitfall for persistent acromegaly follow-up – case report.
Magnetic resonance imaging grading of pituitary macroadenoma – SIPAP classification revisited.
Recent advances in understanding and managing pituitary adenomas.
Cushing’s Disease
Pharmacotherapy for Cushing disease: a recent Australian experience with osilodrostat.
Hormonal Health
Association of Homozygous PROP1 Mutation in a Saudi Family with Combined Pituitary Hormone Deficiency.
Treating Hypopituitarism in the Over 65s: Review of Clinical Studies.
News Articles April 2023
Beware of Cortisol Misinformation on Social Media
An article in Cushing’s Disease News warns of the problem of social media influencers who promote theories or products designed to lower cortisol levels. Read more:
TikToks Fuel Interest in Cortisol
The New York Times also delves into the subject of TikTok videos that blame various ailments on cortisol levels, and gives a primer on what cortisol really does. Read more:
Pachydermoperiostosis: A Condition That Mimics Acromegaly
An article on Cureus.com looks at a case report of a 24-year-old man with pachydermoperiostosis, a disease the has many of the symptoms of acromegaly but can be diagnosed with additional testing. Read more:
Report: Pituitary Microadenomas May Require Less Frequent MRIs
An article in 2-minute medicine looks at a study that found slow growth in pituitary microadenomas, and says that the current standard of repeating an MRI every three years may be safely extended to a longer timeline. Read more:
7-year-old Figure Skater Battles Craniopharyngioma
A story from King 5 News in Seattle tells the story of 7-year-old Rose King, who is fighting a craniopharyngioma and recently had her fourth brain surgery. Read more:
PNA Medical Corner: Machine Learning and Pituitary Surgery
An article co-authored by multiple members of the PNA (Including Drs. Samson, Chaichana, and Quinones-Hinojosa) looks at the role of machine learning in forecasting outcomes of pituitary surgery. They conclude that it is not ready yet as no model achieved clinical applicability.
Link:
Brain Sci
. 2023 Mar 15;13(3):495.
doi: 10.3390/brainsci13030495.
Machine Learning Models to Forecast Outcomes of Pituitary Surgery: A Systematic Review in Quality of Reporting and Current Evidence
• PMID: 36979305 DOI: 10.3390/brainsci13030495
Abstract
Background: The complex nature and heterogeneity involving pituitary surgery results have increased interest in machine learning (ML) applications for prediction of outcomes over the last decade. This study aims to systematically review the characteristics of ML models involving pituitary surgery outcome prediction and assess their reporting quality.
Methods: We searched the PubMed, Scopus, and Web of Knowledge databases for publications on the use of ML to predict pituitary surgery outcomes. We used the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) to assess report quality. Our search strategy was based on the terms “artificial intelligence”, “machine learning”, and “pituitary”.
Results: 20 studies were included in this review. The principal models reported in each article were post-surgical endocrine outcomes (n = 10), tumor management (n = 3), and intra- and postoperative complications (n = 7). Overall, the included studies adhered to a median of 65% (IQR = 60-72%) of TRIPOD criteria, ranging from 43% to 83%. The median reported AUC was 0.84 (IQR = 0.80-0.91). The most popular algorithms were support vector machine (n = 5) and random forest (n = 5). Only two studies reported external validation and adherence to any reporting guideline. Calibration methods were not reported in 15 studies. No model achieved the phase of actual clinical applicability
Conclusion: Applications of ML in the prediction of pituitary outcomes are still nascent, as evidenced by the lack of any model validated for clinical practice. Although studies have demonstrated promising results, greater transparency in model development and reporting is needed to enable their use in clinical practice. Further adherence to reporting guidelines can help increase AI’s real-world utility and improve clinical practice.
Keywords: Cushing disease; acromegaly; adenoma; artificial intelligence; machine learning; outcomes; pituitary adenoma; reporting quality assessment; systematic review
Dr. Susan Samson
Dr. Kaisorn Chaichana
Dr. Alfredo Quinones-Hinojosa
PNA Spotlight: Dr. Yuval Eisenberg
This month the PNA Spotlight shines on Dr. Yuval Eisenberg. Dr. Eisenberg graduated from the Rush Medical College of Rush University Medical Center in 2009. He works in Chicago, IL and 2 other locations and specializes in Endocrinology, Diabetes & Metabolism and Internal Medicine. Dr. Eisenberg is affiliated with 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 both my interaction with patients and my mentors. The highlight of my medical school training was helping to diagnose a suffering young man with multiple endocrine neoplasia type 1 (MEN1), a rare genetic disorder causing multiple (including pituitary) tumors. Listening to his concerns and thinking outside the box 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 diseases are a unique population who are in need of education, support and reassurance at diagnosis and often require long-term follow-up. This allows for time to develop a trusting bond; an aspect of medical practice I thoroughly enjoy.
• What is the primary focus of your work/research?
My main focus is clinical endocrinology practice, and I see a variety of patients, but I have a specialized interest in patients with pituitary disorders. My research interest is in the hormone oxytocin and how it might effect patients with pituitary hormone deficiencies (hypopituitarism).
• What do you consider to be the future of your field?
In my opinion, the future is in specialized and individualized expert care providing for patients with pituitary disorders. Given the rarity of these diseases, patients are best served by provider with interest and experience. Also, the more we know about pituitary tumors and the genetics behind them, the better we will be able to predict patient outcomes and tailor our therapies.
• What should patients know about your field/what deserves more recognition/awareness?
My feeling is that patients need to know that they can/should advocate to get the care they deserve from providers with interest and experience in caring for individuals with their condition. They should also utilize the excellent patient centered resources (like the PNA) to help educate and direct their care.
• What would you like to convey about yourself to your patients?
The best part of my job is helping patients (and their families) understand their condition, their prognosis and their options. It’s tremendously rewarding to help someone feel more comfortable with what is often a completely foreign, and sometimes scary sounding group of diseases. I strive to always spend the time and energy needed to make patients feel more at ease with and educated about their disease.
• Why did you get involved with the PNA and what is the extent of your involvement?
Early in my career, I became excited to become more involved. My mentor has also been involved in the PNA for many years and recommended I become involved, as he found it an excellent resource for patients and providers.
PNA Highlights March 2023
Man needs difficulties; they are necessary for health.
-Carl Jung
PNA Spotlight: Dr. Yuval Eisenberg
This month the PNA Spotlight shines on Dr. Yuval Eisenberg. Dr. Eisenberg graduated from the Rush Medical College of Rush University Medical Center in 2009. He works in Chicago, IL and 2 other locations and specializes in Endocrinology, Diabetes & Metabolism and Internal Medicine. Dr. Eisenberg is affiliated with 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?
PNA Medical Corner: The Size of Pituitary Microadenomas .
This month the PNA Medical Corner showcases a study co-authored by Drs. Edward Laws and Ursula Kaiser, both longtime members of the PNA. The study looks at the size of microadenomas over time. It concludes that two-thirds of microadenomas studied either stayed the same or shrank over time, and therefore that “less frequent pituitary MRI surveillance for patients with incidental pituitary microadenomas may be safe.”
https://www.acpjournals.org/doi/10.7326/M22-1728
Abstract
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News Articles March 2023
Case Study Links Mifepristone in Cushing’s Patient to Liver Damage
A study published in the Journal of Medical Case Reports looks at the experience of a woman with Cushing’s who was treated with Korylm (mifepristone) and who developed liver damage. Read more here:
Or here:
Portable MRI Scanners Proliferate
An article in the magazine “Science” looks at a new generation of portable low-field MRI scanners that make imaging more accessible throughout the world. Read more:
New Classification Scheme for Ovulatory Disorders
An article in “Focus on Reproduction” explains that the international Federation of Gynecology and Obstetrics (FIGO) has come up with a new way to classify ovulatory disorders – adding PCOS as a category, alongside hypothalamus, pituitary and ovary. Read more:
Factors Behind Obesity
An article on Endocrine Web goes over the primary contributors to obesity, which has become a national health threat. Read more:
Cortisol and Energy Levels
An article in Fashion Journal.au explains the role the hormone cortisol plays in people’s energy levels and recommends people concerned about it see a doctor, reduce stress, eat well and get more sleep. Read more:
The Science Behind Stress
An article in epigram.org looks at the biology of stress and the hormones involved. Read more:
PNA Spotlight: Dr. Adriana G. Ioachimescu
This month the PNA Spotlight focuses on endocrinologist Adriana G. Ioachimescu, MD, PhD, FACE at the Medical College of Wisconsin, a lifetime professional member of the PNA.
Prior to her recent move, Dr. Ioachimescu was a Professor of Medicine in Endocrinology and Neurosurgery at the Emory University School of Medicine. Dr. Ioachimescu was also co-director and co-founder of the Emory Neuroendocrine Pituitary Center and a consulting editor at Endocrinology and Metabolism Clinics. Previously she worked at Carol Davila University in Bucharest, Romania, and at the Cleveland Clinic.
Dr. Ioachimescu was born in Bucharest, Romania and earned her PhD in Neuroendocrinology from Carol Davila University of Medicine. She completed an internship in internal medicine at Danbury Hospital and then a fellowship in Endocrinology at the Cleveland Clinic. She did residencies in internal medicine at Carol Davila University, Yale University and the Cleveland Clinic.
Dr. Ioachimescu was kind enough to respond to a few questions from the PNA:
What inspired you to choose your career path?
In medical school, I had a wonderful professor of endocrinology, Dr. Mihai Coculescu, who inspired me to follow this path. Endocrinology was a great fit for me because I loved biochemistry and math. I became fascinated by feedback loops and hormonal circadian rhythms. I noticed the how hormones disturbances influence many organs and systems, especially in patients with pituitary tumors. I was captivated by the link between hormones and the brain and started research in this field early on in my medical career.
What is the primary focus of your work/research?
I am a pituitary endocrinologist, which means I see patients with disorders of the pituitary gland, as well as adrenal disorders that cause high cortisol levels. Together with my neurosurgery colleague, Dr. Oyesiku, I oversee patient care at the Emory Pituitary Center. In terms of research, one of my current interests is to establish prognostication systems for pituitary adenomas, which will allow personalized treatments. Let’s take acromegaly, for example. When I saw my first patient with this condition 25 years ago in Romania, all we had in terms of medical treatment was bromocriptine. We now have available several classes of medications that we use based on a “trial and error” approach. I hope research will move us closer to customized treatment plans that get our patients in control and feeling better faster.
What do you consider to be the future of your field?
These are exciting times for specialists like me who dedicated their career to the pituitary gland. Several histological and molecular markers have been developed that have allowed us to move translational research closer to the patients and their problems. Physicians will soon have the right tools to predict clinical course of pituitary adenomas more precisely and to develop individualized plans to manage them. Also, scientists are working on treatments that specifically target certain genetic or molecular pathways that will create a paradigm shift in how we treat pituitary disorders.
What should patients know about your field/what deserves more recognition/awareness?
Pituitary disorders are complex and usually require a multidisciplinary approach. Every day, I am in contact with neurosurgeons, neuroradiologists, pathologists, radiation oncologists, gynecologists, urologists, psychologists and other specialists. Most importantly, I constantly communicate with the internists or primary care physicians. While the hormones and/or the tumor itself are at the center of the problem, they cause diverse health problems that warrant specific evaluation and management.
What would you like to convey about yourself to your patients?
It is a privilege for me to take care of you. I am honored by the trust you place in me and I will continue to work tirelessly to help you feel better. I know that the same condition affects different patients in different ways and that laboratory results can be confusing. I realize the complexity of your condition. I learn something new every day. I assure you, we make progress in our diagnostic and therapeutic abilities. I am here to guide you through the process and offer you a treatment plan that suits your needs.
Why did you get involved with the PNA; what is the extent of your involvement.
I like working with the PNA because this organization offers a reliable source of information for patients and their families. The PNA has provided valuable patient advocacy in the field of pituitary diseases since 1992. I partnered with PNA ten years ago because we share the goals of improving awareness about pituitary disorders and educating both patients and the medical community. I am a member of the PNA scientific advisory board and together we published books and other educational materials, and we recorded webinars. The PNA staff is friendly and passionate about their mission.
March 2023 Research Articles
Pituitary Tumors
CircOMA1 modulates cabergoline resistance by downregulating ferroptosis in prolactinoma.
The clinical characteristics and gene mutations associated with thyroid hormone resistance syndrome coexisting with pituitary tumors.
AIP gene germline variants in adult Polish patients with apparently sporadic pituitary macroadenomas.
Expression and Clinical Significance of MDM2 in Non-Functioning PitNETs.
Pituitary Surgery
Prospective evaluation of multidimensional health-related quality of life after endoscopic endonasal surgery for pituitary adenomas using the endoscopic endonasal sinus and skull base surgery questionnaire
Bilateral Superficial Trigeminal Nerve Blocks are not more Effective than a Placebo in Abolishing Post-operative Headache in Pituitary Transsphenoidal Neurosurgery: A Prospective, Randomized, Double-blinded Clinical Trial.
Cortisol and ACTH Measurements at Extubation From Pituitary Surgery Predicts Hypothalamic-Pituitary-Adrenal Axis Function.
OptImal Gamma kNife lIghTnIng sOlutioN (IGNITION) score to characterize the solution space of the Gamma Knife FIP optimizer for stereotactic radiosurgery.
Effects of Craniotomy and Endoscopic Endonasal Transsphenoidal Surgery on Bodyweight in Adult-Onset Craniopharyngioma: A Single-Center Retrospective Study.
Pituitary Cancer
Outcome and prognostic factors for pituitary carcinomas: lessons from a systematic review.
Imaging
Multiple Brain Tumor Classification with Dense CNN Architecture Using Brain MRI Images.
Evaluation of preoperative visual pathway impairment in patients with non-functioning pituitary adenoma using diffusion tensor imaging coupled with optical coherence tomography.
PNA Medical Corner: Size of Pituitary Microadenomas
This month the PNA Medical Corner showcases a study co-authored by Drs. Edward Laws and Ursula Kaiser, both longtime members of the PNA. The study looks at the size of microadenomas over time. It concludes that two-thirds of microadenomas studied either stayed the same or shrank over time, and therefore that “less frequent pituitary MRI surveillance for patients with incidental pituitary microadenomas may be safe.
Link:
https://www.acpjournals.org/doi/10.7326/M22-1728
Long-Term Changes in the Size of Pituitary Microadenomas
-
Dawid Hordejuk, BA; Yee-Ming M. Cheung, MD; Wei Wang, PhD; Timothy Smith, MD;
Abstract
Background: The estimated prevalence of pituitary lesions is 10% to 38.5% in radiologic studies. However, how frequently these incidental lesions should be monitored by serial pituitary magnetic resonance imaging (MRI) remains unclear.
Objective: To evaluate changes in pituitary microadenomas over time
Design: Retrospective, longitudinal cohort study.
Setting: Mass General Brigham, Boston, Massachusetts.
Patients: Evidence of pituitary microadenoma from MRI.
Measurements: Dimensions of pituitary microadenomas.
Results: During the study period (from 2003 to 2021), 414 patients with pituitary microadenomas were identified. Of the 177 patients who had more than 1 MRI, 78 had no change in the size of the microadenoma over time, 49 had an increase in size, 34 had a decrease in size, and 16 had both an increase and decrease in size. By linear mixed model analysis, the estimated slope was 0.016 mm/y (95% CI, −0.037 to 0.069). In the subgroup analysis, pituitary adenomas with a baseline size of 4 mm or less tended to increase in size. The estimated slope was 0.09 mm/y (CI, 0.020 to 0.161). In contrast, in the subgroup with baseline tumor size greater than 4 mm, the size tended to decrease. The estimated slope was −0.063 mm/y (CI, −0.141 to 0.015).
Limitation: Retrospective cohort, some patients were lost to follow-up for unknown reasons, and data were limited to local large institutions.
Conclusion: During the study period, approximately two thirds of the microadenomas remained unchanged or decreased in size. The growth, if any, was slow. These findings suggest that less frequent pituitary MRI surveillance for patients with incidental pituitary microadenomas may be safe.
Primary Funding Source: None.
Dr. Edward Laws
Dr. Ursula Kaiser
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