PNA Spotlight: Dr. Eliza Geer

Dr. Eliza GeerThis month the PNA Spotlight focuses on endocrinologist Dr. Eliza Geer, the Medical Director of the Multidisciplinary Pituitary and Skull Base Tumor Center and an Associate Attending in the Endocrine Service at Memorial Sloan Kettering Cancer Center in New York City. Dr. Geer got her medical degree from the Icahn School of Medicine at Mount Sinai Medical Center. She completed her internship and residency at the New York-Presbyterian Hospital/Columbia Medical Center. She then did a fellowship in endocrinology and metabolism at the Icahn School of Medicine/Mount Sinai Medical Center, and served on the faculty there for ten years before joining Memorial Sloan Kettering. She was kind enough to answer some questions from the PNA. Her answers can be found below.

What inspired you to choose your career path? 

I loved biology in high school. It was the perfect mix of science and the study of living things. I then became interested in pursuing medicine, which was a surprise to my family, since none of my relatives are in the medical field. Endocrinology, and specifically neuroendocrinology, blends what I love about internal medicine – the ability to follow and treat people over time, to develop and nurture relationships and have an ongoing dialogue not just about their medical condition but also who they are and who they become over time. The pituitary gland interacts with multiple hormones and organs in the body. It is, by definition, ‘multi-disciplinary’ and requires us to pay attention to many aspects of the body (bones, muscles, fat, metabolic and reproductive health, to name a few) and brain (mood, cognition, sleep, energy, and quality of life). This integrative aspect of neuroendocrinology appeals to me and was one of the reasons I chose this specialty.

What is the primary focus of your work/research?

One of my long standing interests is the study of Cushing’s syndrome. I am interested in the effects of excess cortisol on the body, including body composition and appetite as well as mood and quality of life. I study the natural history of Cushing’s - how people with Cushing’s do over time, during and after their treatment. There is a lot we still don’t understand about Cushing’s. Why don’t measured cortisol levels accurately reflect their clinical effects? Why do people with Cushing’s sometimes have persistent weight or mood difficulties despite that fact that they have been ‘cured’ of their endocrine abnormalities? Why is recurrence rate of ACTH tumors so high after successful surgery, even after many years of remission? We need to understand more about the disconnect between the results of the tests we do as endocrinologists - the number value we see on the lab report - and the experiences of the patients enduring this condition.

I am also interested in studying how pituitary tumors form and I am working to help identify new medical therapies for these tumors, specifically tumors that behave aggressively. We currently have very few effective medical therapies for aggressive pituitary tumors. Our team at MSK recently used immunotherapy to treat one of our patients who has an aggressive ACTH tumor that had failed all conventional therapies. She had a dramatic response and her tumor shrunk markedly. This is the first reported case of a patient with a pituitary tumor treated with immunotherapy and represents a completely new approach to the treatment of pituitary tumors (https://www.ncbi.nlm.nih.gov/pubmed/30085142). We are now developing a clinical trial to use immunotherapy to treat patients with aggressive pituitary tumors. Our multidisciplinary team at MSK is the ideal place for a clinical trial like this, since we have neuro-oncology, neuroendocrine, neurosurgical and genomics expertise, we have a unique collaborative clinic that delivers integrated care, and we have the resources to provide access to advanced therapies. Patients with aggressive pituitary tumors really need help and I am hopeful our team at MSK can make advances in their treatment.

What do you consider to be the future of your field?

The study of the pathogenesis of pituitary tumors – the genetic events that occur in the development of these tumors – is currently an exciting area of research. This work will hopefully identify targets within a tumor that could help predict how it will respond to different medical therapies, and why some tumors recur after treatment and behave more aggressively than others. Most importantly, it can lead to development of personalized, targeted therapy for these tumors.

Another area that is actively evolving is the treatment of Cushing’s syndrome. Ongoing development of new medical therapies for Cushing’s syndrome will hopefully expand treatment options for these patients and improve patients’ quality of life and outcomes. Six years ago there were no FDA-approved medical therapies for Cushing’s in the U.S. Now we have two approved therapies and several more that are being studied in clinical trials, some of which we are involved with at MSK. This work is generating excitement and hopefully will lead to real changes in management of Cushing’s.

What should patients know about your field/what deserves more recognition/awareness?

The importance of a multidisciplinary center for pituitary diseases has appropriately gained attention recently. The buzz word ‘multidisciplinary’ is frequently used, but specific resources for patients at each center varies considerably. To earn the title ‘multidisciplinary pituitary center,’ in my opinion, truly integrated and advanced care for patients is required. This includes a team that has expertise in neuroendocrinology, neurosurgery, head and neck surgery, radiation oncology, neuro-oncology, neuropathology, and neuroradiology; a team that really communicates in the care of their patients; and a team that offers advanced and personalized treatment for each patient. Multidisciplinary pituitary centers need to engage in research and clinical trials that can offer patients new, otherwise unavailable therapies which could make a difference in their care. We should also work on providing additional services for patients. Pituitary patients often need nutritional and dietary advice, physical therapy, support groups, and psychological and psychiatric care with providers who understand their condition. Ideally multidisciplinary centers will focus on developing resources that address patients’ physical and mental recovery, beyond their surgical and endocrine recovery.

What would you like to convey about yourself to your patients?

I approach a patient’s treatment as a dialogue. There is often more than one treatment plan that could be appropriate for a patient. I help each patient understand their condition and explain the treatment options in detail so we can work together to form a plan that is comfortable for them. Of course, when there is one best treatment I make that very clear, and I would never move forward with a plan that is not clinically appropriate or safe. But I emphasize finding an approach that each patient feels good about.

Beyond resources and expertise, what I believe patients need most is the ability to be heard and understood. The ability to communicate freely, to develop trust between the doctor and patient, is essential for recovery. A Cushing’s patient recently told me something very meaningful. A year after her treatment with us, she described the many ways she felt better (she had lost weight, her periods were now regular, her insomnia had resolved, her blood pressure had normalized). Importantly, she told me that she chose our team for her care because, of all the doctors she had consulted with, she felt the safest with us. I was struck by the importance of the sense of safety a patient needs to have when choosing the right medical doctor. I believe that my relationships with my patients create value for them, but my work is not purely altruistic! These relationships create so much reward for me as well.

Why did you get involved with the PNA and what is the extent of your involvement?

It can be challenging for patients to navigate the healthcare system. It is daunting to learn about your disease and identify the right treatment team. It is particularly overwhelming for a patient with a rare disease like a pituitary tumor. General endocrinologists and neurosurgeons often do not have the clinical exposure or expertise to offer ideal care to patients with pituitary tumors. Inaccurate and misleading information on the internet can also lead patients down the wrong path. Resources like the PNA are critical for pituitary patients. The PNA offers valuable, in-depth, sophisticated information for patients – not just to learn about their condition but to find the right doctors and treatments. People with a rare disease can also feel very alone, and PNA provides a community that understands each member’s experience. This sense of belonging, of not being an ‘interesting case’ but being part of a like-minded community, is critical for patients. I joined the PNA and have been an active member so I can help build this resource for patients. I consider it a privilege to be able to share information that can help people who are looking for the care and treatment that they need.

 

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