Innovative Approaches in Neuroendocrinology Expand Treatment Options for Patients with Pituitary Problems

Ursula B. Kaiser, MD, recently appointed Chief of the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women’s Hospital, has been utilizing new medical therapies in neuroendocrinology to treat patients with pituitary tumors and complications of other brain tumor treatment at Brigham and Women’s Hospital and as part of the Center for Neuro-Oncology at Dana- Farber/Brigham and Women’s Cancer Center. Endocrinologists Gail K. Adler, MD, and Robert G. Dluhy, MD, work in conjunction with Dr. Kaiser to care for hundreds of patients with pituitary tumors each year.

New medical therapies offer alternatives to surgery or radiation and help preserve pituitary function for patients with hormone-secreting pituitary tumors, including:

• Prolactin-secreting pituitary adenomas – Medical therapy has become the first line of treatment for patients with a prolactinoma. Dopamine agonists, such as bromocriptine or cabergoline, are effective both in controlling prolactin hormone excess and in reducing tumor size;
• Growth hormone-secreting pituitary tumors (acromegaly) – Octreotide is now available as a longacting injection to help normalize hormone levels and control progression of tumor growth. This medication is used as an adjunct to surgical treatment and is being evaluated as a first line of therapy for these types of tumors. A growth hormone receptor antagonist (pegvisomant) is also available as an alternative in treating acromegaly.

Pioneering Research
Research activities at the Center include the study of:

• Development of neuroendocrine complications following brain tumor treatment and the importance of monitoring neuroendocrine function in this subset of patients;
• Effect of brain trauma on neuroendocrine function;
• Management of obesity that can occur as a complication of hypothalamic tumors and dysfunction;
• Role of genetics in pathogenesis of pituitary tumors, including screening of patients with a family history of pituitary tumors and the use of tumor tissue samples in genetic studies of pituitary tumors.

A Multidisciplinary Approach to Care
A multidisciplinary team of specialists – including neurosurgeons, neuroendocrinologists, radiation oncologists, neurologists, neuro-oncologists, medical oncologists, neuro-ophthalmologists, neuroradiologists, neuropathologists, psychiatrists, nurses, and many other specialists – work together to evaluate and provide the most effective treatment for each patient.

Indications for Referral
Neuroendocrine therapies are available for patients with:

• Pituitary tumors, including pituitary adenomas;
• Pituitary or hypothalamic insufficiencies, including those resulting from previous brain tumor treatment.