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Summer 2007

UCSF Opens New Pituitary Center

After 30 years, the UCSF pituitary treatment program is being redesigned and rebuilt, says UCSF head and neck surgeon Sandeep Kunwar, M.D. The program is reopening as the California Center for Pituitary Disorders. The renewed interest in the treatment of pituitary disorders is based on new surgical technologies, an appreciation for the efficacy of collaborative treatment of pituitary-associated problems and a recognition of the high number of pituitary tumors that exist in the population.

Pituitary tumors are not rare. At some point in life, about one in five people is expected to develop one, according to Kunwar. "The good news is that many of those will cause no symptoms," Kunwar says. "But we don't know what percentage will and what percentage won't."

Pituitary tumors can cause a wide variety of disorders. Depending on type, a pituitary tumor can cause loss of libido, depression, fat accretion on some portions of the body and a decrease in fat on others, high blood cortisol levels, hirsutism, cardiac problems, headache and other afflictions.

The varied nature of these signs and symptoms can make it easy to misdiagnose the true problem. "Patients and their physicians will often come up with rational explanations for each of these things without tying them together and seeing the whole picture," Kunwar says.

One of the most common signs of a possible pituitary tumor in men—inability to get an erection;mdash;is now often ignored because impotence can so easily be treated with sildenafil (Viagra) or other erectile dysfunction drugs. Often, men worry that something more serious is going on only when they experience tunnel vision, Kunwar says.

"It often takes six to eight years before people get a correct diagnosis and treatment," he says.

One of the challenges that clinicians face is to re-educate the physician population about the prevalence of pituitary tumors and to get patients tested. Those patients on erectile dysfunction drugs should be given blood tests, and if those results suggest anything amiss with the pituitary, they should take the next step and get scans, Kunwar says. "We have now convinced fertility centers in the Bay Area to check for values that may indicate a pituitary problem, but that is not the case in the Central Valley or in Oregon," he says.

Because pituitary tumors can interfere with so many body systems, the California Center for Pituitary Disorders hosts many specialists: neurological surgeons, head and neck surgeons, otolaryngologists, neuroanatomists, neuro-ophthalmologists, reproductive endocrinologists, pediatric endocrinologists, cardiologists, diabeticians and others.

Due to its extensive expertise and long history, the UCSF pituitary disorders program has perhaps the largest patient volume of any center of its kind, Kunwar says. Pituitary surgery was significantly advanced through work done decades ago by UCSF Professor Emeritus Charlie Wilson, M.D., D.Sc., who pioneered the trans-sphenoidal approach to the pituitary. "He didn't invent the technique, but demonstrated how effective it could be," Kunwar says. Wilson ultimately performed more than 3,300 trans-sphenoidal surgeries.

The potential for treating pituitary tumors has dramatically increased with the use of minimally invasive skull surgery. With minimally invasive techniques, the pituitary is accessed with endoscopic instruments through the nasal cavity. There is no need for extensive cutting of tissue or chiseling of bone, so the operation can be safer and the recovery after surgery quicker.

Endoscopic equipment also allows good visual imaging of the tumor during the operation, making it easier to spot bits of tumor. Still, Kunwar says, the operation is very delicate, like "peeling tissue of an orange."

Dr. Sandeep Kunwar can be reached at (415) 353-7500.

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