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New Clinic Addresses Overlooked, Yet Endemic Pituitary Problems

Thursday, February 22, 2007

A neurosurgeon and endocrinologist are joining forces to streamline and improve care for patients suffering from pituitary tumors, an affliction which can effect up to 20 percent of the population. The Neuro-Endocrinology clinic is the first of its kind in upstate New York, where two specialists review test results and discuss treatment options at the same time, in the same room, with patients.

Known as the “master gland” due to the large number of hormone functions it controls, diagnosing pituitary tumors can be very difficult, said endocrinologist Laura M. Calvi, M.D.  In addition, some of the diseases caused by pituitary tumors are extremely rare and require a specialized team approach by clinicians who have expertise in detecting and managing them.

“While some tumors of the pituitary gland may never cause a health problem for some people, others can trigger a slew of hyper- or hypo-hormonal responses that can manifest in obvious symptoms, or, the symptoms can accrue gradually,” Calvi said. “Factor in varying degrees of tumor size and location, and you have a bevy of symptoms that physicians must tease out and understand before landing on a correct diagnosis. 

 According to G. Edward Vates, M.D., Ph.D., the neurosurgeon who makes up the other half of the physician team running the Neuro-Endocrinology clinic, symptoms often can be overlooked, or mistakenly attributed to other ailments.

“For example, with the popularity of erectile dysfunction drugs, men may be taking the medication for impotence, when in fact they have a pituitary tumor that is suppressing the normal secretion of testosterone,” Vates said. “The diagnosis and management of pituitary and other neuro-endocrine disorders can be quite complicated, and requires the efforts of doctors from multiple disciplines.”

Vates, who is assistant professor in the Department of Neurosurgery, championed the multidisciplinary clinic concept when he arrived from the University of California at San Francisco in 2004.  He quickly found his way to Calvi, an assistant professor of Medicine in the Division of Endocrinology.  Calvi received her training in Neuroendocrinology at Massachusetts GeneralHospital in Boston, a busy referral center where pituitary cases are also evaluated in a multidisciplinary setting.  She and Vates agreed that such a multi-disciplinary approach, including the ability to review test results at the same time while in the same room with a patient, would be the best way to provide care to these patients.

“The Neuro-Endocrine Clinic allows us to have wide-ranging discussions with our patients, fully exploring all treatment options, and the pros and cons of each,” Vates added. “The patient has the benefit of hearing how two different specialists arrive at treatment recommendations.”

It also is an incredibly convenient and efficient process for patients, who previously could spend months taking tests and seeing various physicians to learn about all the different options available to treat their particular condition. 

“Now, when patients call to make an appointment, they are given a series of tests to complete before we meet with them,” Calvi said. “In that way, we have all the information we need to fully understand their medical condition, and can discuss all the options at the same time, together. This saves patients, many of whom travel long distances to see us, a lot of back and forth.”

New Surgical Technique       

If patients are surgical candidates, Vates also can review with them a new, less-invasive way to remove pituitary tumors, where instruments are funneled down the nasal passage to reach the tumor. Currently, most surgeons either make an incision under the lip, and then proceed through the nasal passage, or just cut directly into the nose. 

“Smaller instruments and better imaging allow us to safely and efficiently remove pituitary tumors in a way that is less painful, less disfiguring, and with equal assurance that the tumor can be removed completely with very low risk of recurrence,” Vates said. “In addition, it allows for a much quicker recovery, with most patients able to resume a full schedule within two weeks of the surgery.”

According to Vates, who is the region’s only surgeon trained in performing this minimally invasive procedure, more than half of patients go home the first day after surgery, and almost 90 percent of patients go home within 48 hours of surgery. This contrasts with the longer recovery time seen in patients treated with the older approach, which routinely commits patients to a two or three-day hospital stay and is associated with more facial pain.

Surgery is not an option for all patients, and in fact, Vates recommends first exploring medical management unless obvious symptoms such as loss of peripheral vision or major changes in pituitary function are present.

Both Vates and Calvi stressed the importance of the multidisciplinary support team necessary to make the clinic function including Nurse Practitioner Cathy Hastings, who coordinates testing and communications with both the patient and his/her primary care physician; as well as experts in Radiation Oncology, Neuro-Ophthalmology, and Imaging Sciences.

Pituitary Tumors in a Glance

Because the pituitary gland secretes many different hormones, and not all pituitary tumors secrete hormones, the symptoms of a pituitary tumor are variable and difficult to interpret.  Below is a list of the most common tumors:

Endocrine-Inactive Tumors

These tumors do not secrete hormones.  Symptoms typically are caused by its size, and can include decreased peripheral vision, headaches, or nausea.

Endocrine-Active Tumors

These tumors secrete a particular hormone, causing symptoms related to elevated levels of that particular hormone. The most common types of ailments caused by these adenomas include:

·         Giantism and Acromegaly: Hypersecretion of growth hormone, causing extreme growth spurts in children or soft tissue growth in adults.

·         Hyperprolactinemia: Hypersecretion of prolactin, causing women who are not pregnant to produce breast milk and to stop menstruating. In men, it can cause impotence or breast enlargement.

·         Cushing’s Disease: Hyperproduction of ACTH stimulates overproduction of glucocorticoids, causing a malignant form of diabetes, as well as uneven build-up of fatty tissue on the face, back and chest, and osteoporosis.

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