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grow out of control. When that happens, severe
hormonal abnormalities can result. Neurological
dysfunction, rapid growth, infertility and
problems related to an overproduction of
hormones such as prolactin (absent periods,
reduced libido and breast milk production),
growth hormone (enlargement of body parts,
high blood pressure and heart disease), cortisol
(obesity, high blood sugar and high blood
“With the endoscope, we can
literally look around corners
and see things we were
completely blinded to in
the recent past. It’s a whole
different surgery now.”
pressure, for example) are among the most
debilitating symptoms. Because pituitary tumors
often masquerade as other clinical conditions,
multidisciplinary evaluation and treatment are
needed to address potentially life-threatening
complications that arise when hormone-secreting
tumor cells grow out of control.
When surgery is called for, the endoscopic
approach, which may be used to remove most
pituitary tumors, reduces the chance that residual
tumor cells will be left behind and may be
associated with improved cure rates, according to
Dr. Bergsneider. To date, more than 500 endoscopic
pituitary-tumor surgeries have been performed at
UCLA. For the rare case in which a pituitary tumor
extends laterally into the brain cavity, UCLA
surgeons are experts at the minimally invasive
“key-hole” craniotomy (opening of the skull),
utilizing a small incision hidden in the eyebrow to
access and remove the tumor.
Despite important surgical advances over the
last decade, Dr. Bergsneider emphasizes that
abnormalities associated with hormone-secreting
pituitary tumor cells, rather than the actual
tumors, are most problematic if left untreated.
At UCLA, experts in the Pituitary Tumor and
Neuroendocrine Program collaborate to provide
comprehensive evaluation and management
for all types of pituitary tumors and related
disorders. Outpatient evaluations are available,
often within 24-to-48 hours of initial contact, by
a UCLA neurosurgeon, endocrinologist and
other pituitary-tumor experts, during a single,
coordinated visit.
“Many patients with pituitary tumors face serious
disease morbidity or mortality caused by excess
hormones secreted from the pituitary tumor cells
or following treatment for the tumors, such as
repeated surgery and/or radiation therapy, that can
damage the pituitary gland,” says endocrionologist
Anthony Heaney, MD, PhD, codirector of the
UCLA Pituitary Tumor Program. “The beauty of
our program is that we work together to accurately
identify these problems, which are not always
obvious, and then we collectively employ multiple
strategies to fix them.”
For example, Cushing’s disease is a relatively rare
but potentially life-threatening hormonal disorder
caused by prolonged exposure of the body’s
tissues to high levels of the hormone cortisol. The
symptoms of Cushing’s disease are sometimes
difficult to differentiate from other conditions
and may require months of testing to reach a
definitive diagnosis. Once diagnosed, however,
surgery is performed to remove the tumor.
Newly FDA-approved medications are also now
available to manage this debilitating disease.
“We’re attempting to get at the heart of what
drives hormone production in Cushing’s disease,”
Dr. Heaney says. “Discovery of factors that
impact adrenocorticotrophic hormone (ACTH)
in Cushing’s has the potential to go from bench
to bedside and may have applications in related
disorders where altered cortisol dynamics may
play a role, including certain forms of depression
and metabolic syndrome.” Dr. Heaney and
colleagues recently published findings related to
a potential novel therapeutic target in Cushing’s
disease in the Proceedings of the National
Academy of Sciences.
Top: Pituitary tumor, pre-op.
Bottom: Pituitary tumor, post-op.
UCLA also is participating in several multicenter
clinical trials to evaluate the efficacy of
new medications for treatment of various
pituitary tumors, including acromegaly and
Cushing’s disease.
9 UCLA Physicians Update