Pituitary Center of Excellence Established at UPMC Presbyterian

The optimal management of pituitary tumors requires complex and seamless coordination between a multidisciplinary team of care providers. This multidisciplinary team consists of specialists in neuroendocrinology and neurosurgery, as well as otorhinolaryngology, neuro-ophthalmology, neuroradiology, neuropathology, endovascular neurosurgery, neuro-oncology, and radiation oncology, among others. Recently, centers of excellence have been established in several specialties to designate institutions with the expertise, resources, and the ability to achieve optimal patient outcomes¹ and in 2017, the International Pituitary Society proposed criteria for a Pituitary Center of Excellence.²

The characteristics proposed by the Pituitary Society for a Pituitary Center of Excellence include centers performing a high volume of pituitary surgeries, centers with a widely recognized group of multidisciplinary providers that are able to provide the best possible care for patients with pituitary pathology, centers that are leaders in training residents and fellows in the treatment of pituitary disease, and centers that provide community outreach and support to endocrinologists outside the Pituitary Center of Excellence.²

As a founding leader in endoscopic endonasal techniques, the team of pituitary surgery experts at UPMC, consisting of Paul Gardner, MD, and Georgios Zenonos, MD, both from the Department of Neurosurgery, and Carl Snyderman, MD, MBA, and Eric Wang, MD, both from the Department of Otolaryngology, far surpasses the criteria set by the Pituitary Society for yearly pituitary surgical volume. The surgical team is an unrivaled international leader in pioneering new techniques in endoscopic endonasal resection of tumors and educating neurosurgeons and otorhinolaryngologists around the world on these techniques.

In addition to surgical volume, the establishment of an innovative inpatient service aimed at optimizing the care of pituitary tumor patients sets us apart as a clear leader in pituitary tumor care. In November of 2019, an inpatient neuroendocrine service was established at UPMC Presbyterian. The service is staffed by a team of three neuroendocrine subspecialists who personally follow patients admitted to UPMC with pituitary pathology including all patients undergoing pituitary surgery. Since its inception, the team consisting of neuroendocrinologists Hussain Mahmud, MD, Esra Karslioglu-French MD, MBA, ECNU, and Pouneh K. Fazeli, MD, MPH, have performed nearly 400 inpatient consults. This specialized inpatient team has developed protocols to optimize the endocrine management of post-surgical pituitary patients, and the neuroendocrine service is continuously assessing the outcomes of these protocols through quality improvement analyses. 

The team has also been a leader in educating the next generation of pituitary experts. In addition to the formally established surgical fellowships in neurosurgery and otorhinolaryngology for subspecialty training in endoscopic endonasal techniques, the Neuroendocrinology Unit has established weekly neuroendocrine rounds attended by all clinical endocrine fellows, medical residents, and advanced practice providers. At these formal weekly rounds, the management of all inpatients on the neuroendocrine service are discussed and reviewed in detail. In addition, University of Pittsburgh medical students, residents, and fellows actively participate in neuroendocrine research protocols and quality improvement projects. A monthly Multidisciplinary Pituitary Conference is also held which further highlights the coordinated management of pituitary tumor patients by an interdisciplinary group of subspecialty experts. Discussion of each patient’s case includes input from neuroendocrine, neurosurgery, neuroradiology, neuropathology, and often neuroophthalmology and radiation oncology. The conference is widely attended by members of the UPMC community and is a required conference for trainees, illustrating another important way in which the pituitary center is training future pituitary tumor subspecialists. 

In 2021, UPMC Presbyterian was formally accredited as a Pituitary Center of Excellence with Dr. Pouneh Fazeli serving as medical director, and Dr. Paul Gardner serving as surgical director. This accreditation underscores the dedication of the Pituitary Center and its members to providing optimal, personalized care for patients with pituitary disease. Highlights of the Center’s first year include the development of a virtual webinar on the “Multidisciplinary Management of Pituitary Tumors,” which consisted of more than eight hours of lectures and was attended by more than 100 national and international participants.

Members of the Pituitary Center of Excellence also participated in providing international guidance on the management of pituitary tumors during the early stages of the COVID-19 pandemic.^3-7 UPMC Presbyterian is also a newly established site for studies investigating medications for the treatment of functional pituitary tumors, such as Cushing’s and acromegaly, providing patients access to new state of the art therapies.

For more information regarding the Pituitary Center of Excellence at UPMC Presbyterian, please contact 412-586-9700.

References

1. Elrod JK, Fortenberry JL. Centers of excellence in healthcare institutions: what they are and how to assemble them. BMC Health Serv Res. 2017;17(Suppl 1):425.

2. Casanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS, Melmed S, Mortini P, Wass J, Giustina A, Pituitary Society EpGoPT. Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement. Pituitary. 2017;20(5):489- 498.

3. Fleseriu M, Buchfelder M, Cetas JS, Fazeli PK, Mallea-Gil SM, Gurnell M, McCormack A, Pineyro MM, Syro LV, Tritos NA, Marcus HJ. Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic-an international perspective. Pituitary. 2020;23(4):327-337.

4. Taneja C, Fazeli PK, Gardner PA, Wang EW, Snyderman CH, Mahmud H. Rapidly Progressive Pituitary Apoplexy in a Patient with COVID-19 Disease Treated with Endoscopic Endonasal Surgery. J Neurol Surg Rep. 2022;83(1):e8-e12.

5. Champagne PO, McDowell MM, Wang EW, Snyderman CH, Zenonos GA, Gardner PA. Early practices in endonasal skull base surgery during the COVID-19 pandemic: a global survey. Neurosurg Focus. 2020;49(6):E12.

6. Dharmarajan H, Freiser ME, Sim E, Boorgu DSSK, Corcoran TE, Wang EW, Gardner PA, Snyderman CH. Droplet and Aerosol Generation With Endonasal Surgery: Methods to Mitigate Risk During the COVID-19 Pandemic. Otolaryngol Head Neck Surg. 2021;164(2):285-293.

7. Snyderman CH, Gardner PA. Endonasal drilling may be employed safely in the COVID-19 era. Int Forum Allergy Rhinol. 2020;10(9):1118-1119.