Keep your vitality. A life without health is like a river without water.” – Maxime Lagacé 

PNA Spotlight: Dr. Fredric B. Meyer

This month the PNA Spotlight focuses on Fredric B. Meyer, M.D., a consultant and professor of neurologic surgery and enterprise chair of the Department of Neurologic Surgery at Mayo Clinic in Rochester, Minnesota.  He holds the Alfred Uihlein Family Professorship of Neurologic Surgery. He is also the Juanita Kious Waugh Executive Dean of Education of the Mayo Clinic College of Medicine and Science, and Dean of the Mayo Clinic Alix School of Medicine.  He studied biology at the University of Pennsylvania, earned his MD at Boston University, and completed residency and fellowship in neurologic surgery at the Mayo Clinic School of Graduate Medical Education, which is part of Mayo Clinic College of Medicine.  He was kind enough to answer questions from the PNA; his answers follow.

Tell me about your educational journey.

I went to college at University of Pennsylvania and then to medical school at Boston University. I completed seven years of neurological surgery training at Mayo Clinic along with several fellowships before staying on staff at Mayo. I trained with Dr. Edward Laws, who taught me much about skull base and pituitary surgery.

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PNA Medical Corner: Dopamine-2 and prolactinomas

   This month the PNA Medical Corner features a study coauthored by a member of the PNA, Dr. Kalmon Post, a neurosurgeon at Mount Sinai Hospital in New York. The study looks at dopamine-2 receptor expression in prolactinomas and has implications on the wisdom of continuing dopamine agonist therapy in some patients.

J Clin Med . 2025 Oct 17;14(20):7344.

doi: 10.3390/jcm14207344.

Immunohistochemical Comparison of Dopamine-2 Receptor Expression in Resistant and Non-Resistant Prolactinomas

Ilana Ramer Bass ¹, Julia Ferreira de Carvalho ¹, Melissa Umphlett ², William Shuman ³, Alexander Kirschenbaum ⁴, Emily Milgrim ¹, Lucas Milgrim ¹, Joshua Bederson ³, Kalmon Post ³, Raj Shrivastava ³, Alice C Levine ¹

Affiliations Expand

• PMID: 41156214  DOI: 10.3390/jcm14207344

Abstract

Background: Dopamine agonists (DAs) are first-line therapy for prolactin-secreting pituitary adenomas; however, a small proportion of tumors are resistant. Previous reports suggested that reduced D2R mRNA expression might cause resistance. This study aimed to determine if resistant prolactinomas express D2R protein. We also explored a role of estrogen receptor alpha (ERα) expression in DA resistance. Methods: We retrospectively selected 15 tumor specimens from 13 total patients (8 controls from 8 patients, 7 from 5 resistant patients) with resected lactotroph cell-type tumors. We reviewed age at diagnosis, tumor size, initial prolactin level, medical treatment, and reason for surgery. Immunohistochemistry was performed for D2R, prolactin, and ERα protein expression. Results: D2R expression was positive in seven of eight controls vs. two of seven in resistant tumors (p = 0.02). ERα expression did not significantly correlate with DA resistance. The two D2R expressing resistant tumors were ERα negative and both derived from a pre-pubertal female, supporting prior reports suggesting ERα may modulate DA therapy response. Conclusions: Our study introduces a reproducible method for assessing D2R protein expression in prolactinomas using commercially available D2R antibodies. Our findings align with current evidence indicating that lack of D2R expression, previously indicated by decreased mRNA levels, is common in DA-resistant prolactinomas and provide a basis for discontinuation of DA therapy to avoid potential harm to these patients.

Keywords: D2 receptors; dopamine agonist; prolactinoma; resistance.

Patient story: Panhypopit patient in a bind as Humatrope is discontinued

Tara Cummins, a pituitary patient in Klamath Falls, Oregon, says she’s at her wits’ end because the medication she depends on, Humatrope, is being discontinued by pharmaceutical giant Eli Lilly. Humatrope is Lilly’s version of somatropin, used to keep people like Cummins alive. Cummins suffers from panhypopituitarism, which developed after pituitary failure soon after a hysterectomy done in 1992 to counter painful recurring ovarian cysts.  She also experienced pituitary failure.

Cummins has no health insurance because she makes too much to qualify for Medicaid and cannot afford to buy insurance on the individual market.  In addition, when she had insurance, it didn’t cover the medication she needed. She sued the insurance company, saying, “Policies are allowed to be changed and modified to under-cover conditions or medications or exclude treatment for certain conditions.  Early on after my settlement with the insurance company (where I still maintained my policy) they changed the terms of the policy, leaving me with a choice of having insurance but not coverage (or adequate coverage) for the somatropin which left me with out-of-pocket expenses that almost no one would be able to afford. With no insurance, I could qualify for patient assistance directly through the manufacturer. The term used was being under insured; as if I had any option to be more insured.”

So, Cummins has been paying for doctor visits on her own and she relies on Eli Lilly’s patient assistance program for free access to her medication: 1 mg each night.  At age 63, it’ll be a little more than a year before the retiree qualifies for Medicare. In the past, she took Pfizer’s version of the medication, Genatropin, but Pfizer discontinued its patient assistance program two years ago, and the medication costs between $5,800 and $16,000 a month if you don’t have insurance.

Cummins says she hopes to get one more shipment from Eli Lilly, which would last her about four months.  She says she’s been told that her life expectancy without the medication is about two years.

Complicating matters, Novo Nordisk’s Norditropin Flexpro subcutaneous solution for injection, is on shortage as of September. On ashp.com, the shortage is attributed “to increased demand and manufacturing delays.”  The site notes that Ferring has Zomacton available; that Genentech discontinued Nutropin AQ Nuspin presentations in December 2024; that Pfizer has Genotropin available (but discontinued the patient assistance program); and that Sandoz has Omnitrope available.

In addition, Cummins had her thyroid removed and relies on natural thyroid medication.  However, the FDA announced in August that it wants animal-derived thyroid medications off the market because they are not FDA approved and “contain many compounds that are uncharacterized for safety and effectiveness.”  The FDA estimates that “1.5 million patients received prescriptions for these medications from U.S. outpatient retail pharmacies in 2024.”

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