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Fast-growing Neuroendocrine Program Introduces Minimally Invasive Surgeries
URMC endocrinologists and neurosurgeons are collaborating to streamline care for people with pituitary and hypothalamic disorders, including the introduction of endoscopic surgeries.
“The multidisciplinary team approach is unique in this region and provides comprehensive care for patients with sometimes challenging disorders,” said neurosurgeon G. Edward Vates, M.D., Ph.D., who leads the Multidisciplinary Neuroendocrine Center with endocrinologist Laura Calvi, M.D.
The program specializes in assessing the combinations of symptoms and searching for the source, often leading to the pituitary gland. Pituitary adenomas are found in as many as one in five people and can have a broad impact on body function. They are difficult to diagnose because symptoms, such as depression, hypertension, infertility, thyroid disorders and obesity, are common and can often be managed with medication, without ever getting to the root of the problem.
“For some patients it takes a phenomenal amount of time to get a diagnosis and treatment,” said Calvi, who joined the Medical Center in 2002. She completed her training with leaders in the field at Massachusetts General Hospital, which has a large multidisciplinary program for pituitary problems.
Vates and Calvi built on that model and created the region’s first program in 2006, which has grown into one of the busiest programs in the state, outside of New York City. Last year the specialists cared for nearly 400 new patients from across upstate.
Working with physicians, endocrinologists, gynecologists and a variety of other specialists, the team identifies patients’ symptoms and the source, and then provides the care needed to allow them to return to their physicians’ care, said Vates.
“We review each patient’s medical history, meet with them together to tell them what we think is best, and answer all of their questions,” said Calvi. “We take the time to review all of their health information and concerns and explain how our treatment plan will benefit each patient.”
The multidisciplinary team, which includes endocrinologists, neurosurgeons, head and neck surgeons, radiation oncologists, and neuro-imaging and neuro-ophthalmology experts, detects and treats abnormalities in hormone production, benign tumors or genetic disorders. Most patients receive a combination of medicinal, surgical and radiation therapy as part of the treatment regimen.
Otolaryngologist Matthew Miller, M.D., joined the Medical Center in 2009 and has become an integral part of the neuroendocrine surgical team, introducing endoscopic surgical techniques to the program.
“Endoscopy puts us in the front-row seat for surgery. The way the pituitary surgery has been done is with a microscope, which is like doing surgery as you look into the window of a narrow room,” Miller said. “Using the endoscope, it’s like looking out a window into a wide open space. Surgeons get much better visualization and as a result, patients get much better treatment.”
Working alongside Vates in the operating room, Miller opens the sinus and nasal cavities to allow his colleague easier access to the gland for removal of a mass. The joint effort reduces surgical time and complications.
Following the procedure, the surgeons not only determine the efficacy of the surgery, but also look for signs of scarring or the development of chronic sinusitis, which can be treated early to avoid further problems.
“We’re using that appointment as a way to prevent future problems and it’s working well for our patients,” Miller said.
Patients also benefit from the state-of-the-art radiation technology and physician expertise available at the James P. Wilmot Cancer Center. Intensity-modulated radiation therapy and the Novalis and Trilogy systems offer greater precision for targeted radiation therapy.
The team also cares for brain cancer survivors who face pituitary gland problems. “It’s not uncommon for people who have had radiation therapy anywhere in the head or brain to suffer damage to the pituitary gland. These types of late-effects from treatment need to be addressed quickly to allow patients to return to normalcy,” Vates said.
For more information
Multidisciplinary Neuroendocrine Center
Strong Consult and Transfer Center