The Pituitary Program team has expertise in treating the full spectrum of pituitary disorders, drawing patients with benign and malignant tumors, acromegaly, and Cushing’s disease from a wide geographic radius. Duke is also considered a Pituitary Center of Excellence by the Pituitary Network Association.

“While pituitary conditions like malignant tumors, acromegaly, and Cushing’s disease are uncommon, we treat a greater volume of patients with these conditions due to our experience,” says Shahla. “We mobilize specialists based on what each patient needs, including neuroendocrinologists, neurosurgeons, radiation oncologists, pathologists, neuro-ophthalmologists, and others.”

Patients can come to Duke at any point in their care — for diagnosis, second opinion, operative management, perioperative assessment, or surveillance. “If patients aren’t local and travel to us for our expertise, we can provide care or advise their local referring provider to deliver their care closer to home,” says Shahla. “We support treatment in the best location for the patient.” 

The team also offers telemedicine appointments when appropriate to provide patients with more convenient options. 

The rate of diagnosed pituitary disorders is rising due to advancements in and access to imaging tests. “Adenomas are common incidental findings. Patients get an MRI for a headache or CT after MVA and an adenoma is identified,” says Shahla. From there, a referral to the Pituitary Program for a full work-up is indicated.

Primary care providers and community endocrinologists can also support patients by screening for and identifying symptoms and signs of potential pituitary dysfunction. “PCPs often see cases of male hypogonadism. Sometimes it’s treated right away, but it’s important to look for the cause; it could be due to an underlying pituitary tumor that we can diagnose and treat,” says Shahla. 

In women, pituitary tumors can create hormonal imbalances that surface as irregular menstrual cycles or amenorrhea. Other patients with uncontrolled or difficult-to-control diabetes may have Cushing’s disease or acromegaly. “If we can flag these patients and get them to an endocrinologist for testing, we can get to the root cause — and treatment — faster,” says Shahla.

“Pituitary tumors are unique — even if they are benign, they can be functioning, or producing hormones, that could significantly affect the patient,” says Shahla. 

For example, functioning tumors in women can produce prolactin. For some patients, medication can resolve the issue. For others, surgery is required. Shahla says the team must understand the big picture before creating a treatment plan, which can involve surgical resection and coordination with the neurosurgery team. 

Cushing’s disease tumors can produce ACTH, which increases cortisol levels, and acromegaly tumors can cause increased production of growth hormones. These conditions frequently require surgery, which may not result in a cure. “Patients with Cushing’s and acromegaly may need additional radiation or mediation therapy. Even if surgery cures their disease, they still need longer-term follow-up care from an experienced neuroendocrine specialist,” says Shahla. 

“Getting surgical evaluation and care for a pituitary tumor from an experienced neurosurgeon is critical to patients’ surgical and long-term outcomes,” says Komisarow. “Our team has extensive expertise in treating these tumors.”

In cases of acromegaly and Cushing’s, after surgery, patients will need long-term surveillance and may require hormone replacement therapy,” says Shahla. Cases are closely monitored and reviewed with the neurosurgery team due to possible tumor reoccurrence and the need for additional surgeries.