It started several years ago, when Ronald Tekel went to his doctor in Arizona for a routine checkup. A blood test revealed a high calcium level. Months later, an endocrinologist conducted further tests, which showed an irregularity in a hormone called human growth factor.
Then Tekel relocated to Bethesda. Additional tests confirmed other hormone levels were abnormal, which indicated a problem with the pituitary gland. He was referred to MedStar Washington Hospital Center, where a team of pituitary specialists could examine him and develop a treatment plan.
Edward Aulisi, MD, a neurosurgeon who specializes in endocrine tumors, confirmed an unusual condition: acromegaly, a benign pituitary tumor in the base of his skull.
“The signs had been there all along,” Tekel says, “but they were subtle,” He had a jutting jaw and his shoe size was increasing, both characteristic of acromegaly.
The tumor needed to be removed. In the May 2015 surgery, Stanley Chia, MD, otolaryngology, created a small tunnel under Tekel’s upper lip into his nasal cavity, and opened the sinus where the tumor was located. Dr. Aulisi then removed the tumor without opening his skull.
“The surgery was on a Monday, and I went home on Thursday,” Tekel, now 59, recalls. After two weeks, he was enjoying all the activities of daily living, and with more energy. “I was very happy with the care and direction I received,” he says. “The doctors took a wider view of my body and me to come up with the right diagnosis.”
This is but one case that showcases the expertise of the MedStar Pituitary Center, the region’s only such program, located at the Hospital Center. The Center integrates care in one place to diagnose and treat the full gamut of pituitary conditions.
The Pituitary Gland and Tumors
The pituitary gland produces hormones that travel around the body directing specific processes. The size of a pea, it is located at the base of the brain. Several kinds of tumors can occur, and almost all are not cancerous. Some tumors secrete too much hormone, others secrete too little; either condition may require medical treatment or surgery. Pituitary tumors can also press on other areas of the brain, causing headaches, vision problems and other side effects.
That’s why a pituitary tumor requires the expertise of several different kinds of specialists. An endocrinologist manages hormone irregularities; a neuroophthalmologist addresses vision problems; a neuroradiologist interprets imaging results; an otolaryngologist specializes in ear, nose and throat surgery; a neurosurgeon specializes in brain surgery. Together, these specialists can diagnose precisely what is going wrong and devise the best treatment plan. “This is one of only a few programs that is focused on pituitary treatment,” Dr. Chia says. “We offer a true multidisciplinary approach.
“We provide one-stop shopping for patients with all kinds of pituitary disorders,” says Dr. Aulisi, medical director of the Center. “We offer first opinions, second opinions, and we treat the most complicated cases.”
The Treatment Path
A patient coordinator schedules appointments and manages all facets of care. The patient sees all the doctors who may be involved in his or her care in one place at one time. The first step is evaluation and diagnosis. After a thorough physical exam, the team can order blood work and sophisticated imaging tests that confirm the diagnosis.
After diagnosis, the team decides on the best course of action. For some patients, a “watch and wait” approach is best; others may benefit from medication to control the tumor’s growth; some need to have the tumor removed surgically.
The MedStar Pituitary Center performs the most advanced surgeries that offer the best outcomes with the least invasive surgery. Some patients, like Ronald Tekel, have tumors removed through tiny incisions under their upper lip. Other patients may have tumors removed through their nasal cavity. A few patients need a more extensive surgery through the skull.
Drs. Aulisi and Chia have years of experience working together and perform these kinds of surgery every week in a specially equipped operating room with image-guidance technology.
Because pituitary tumors can recur, long-term follow-up is required. Some recurrent tumors may respond to a special kind of intense, focused radiation, delivered by the hospital’s Gamma Knife. “We focus on developing long-term relationships with our patients,” Dr. Aulisi concludes. “This ensures the best results.”
Symptoms of Pituitary Tumors
- Blurred or double vision
- Sexual dysfunction
- Unintended weight loss or gain
- Body hair loss or excess growth
- Menstrual irregularity
- Milky discharge from breasts
- Coarsened facial features
- Enlarged hands and feet