The pituitary disorders clinic treats complex endocrine problems

By Greg Jenkins

For a gland the size of a pea, the pituitary is responsible for a lot of physiological duties. It secretes hormones that fully or partially regulate growth, sexual function, blood pressure, breast milk production, metabolism, kidney function, some aspects of pregnancy and childbirth, thyroid gland function, and more.

With that much responsibility, things can occasionally go wrong. Excess or deficient production of hormones can lead to a number of unpleasant and hard-to-pronounce conditions, most of which are treatable. And that’s where the pituitary gland disorders clinic at Duke Endocrinology comes in.

Expert Care for Complex Pituitary Conditions

Fellowship-trained endocrinologists Jennifer Perkins, MD, and Tracy Setji, MD, started the pituitary clinic to better address the diagnostic and treatment needs of patients with pituitary problems -- which can be complex.

“Some of the disorders of the pituitary require provocative testing,” Perkins says. “If an endocrine function is elevated, diagnostically, you may try to suppress it. If you think something is deficient, you may try to stimulate it. That’s why pituitary testing can get quite complicated. You need time to interpret it, and a lab that’s capable of doing it correctly.”

Perkins, Setji, and their colleagues provide exactly that. The pituitary disorders clinic can see about a dozen patients each day the clinic is open (currently Friday only).

Referrals come in and out of the clinic: a primary care physician might need testing and evaluation of a patient who then is referred to a neurosurgeon. Or, a neurosurgeon may discover a pituitary tumor and need an endocrine workup before operating. OB-GYNs send patients who have high prolactin levels that might be causing irregular menstrual cycles or difficulty getting pregnant.

Preserving Continuity of Care

Often, patients from both surgical and nonsurgical referrals follow up with periodic visits to the clinic.

Follow-up is especially important for neurosurgical patients, because surgery can lead to pituitary deficiencies. One positive consequence of the clinic is that Perkins, Setji, and other Duke endocrinologists are becoming more involved in treatment of surgical patients.

“We’re developing a relationship with neurosurgery to help preoperatively and postoperatively as appropriate,” Perkins says. “It offers better continuity of care for patients.”

Personalizing Patient Care

Raleigh resident Ken Lowery, 59, came to Duke University Hospital with pituitary apoplexy, an endocrine emergency in which he was bleeding into a pituitary tumor -- one he didn’t even know he had. The day after surgery for the apoplexy, Lowery began seeing Perkins.

“She informed me of all the possible effects the tumor could have on the pituitary gland’s output, which was very helpful in understanding the reason I felt the way I did,” Lowery says.

“In the months that followed, my visits to Duke’s clinics have shown how much the receptionists, nurses, lab techs, and especially Dr. Perkins genuinely care about their patients. The care I was given changed a scary diagnosis into an ordinary treatable experience.”

Making a Difference in Patients' Lives

Pituitary disorders are not necessarily mysterious, just uncommon. Aside from Cushing’s disease, these unusual ailments can be relatively simple for a specialized clinic to diagnose and treat. That allows Duke’s pituitary disorders staff to make a big difference in the lives of people with many different problems.

“We see women who have high prolactin levels and can’t get pregnant,” says Perkins. “Often, if that is the only reason for infertility, you treat them, and they can get pregnant. That’s a huge success story. Other positive outcomes include when surgery for a pituitary tumor is able to restore a patient’s vision deficit caused by the tumor.

“And to be able to cure Cushing’s disease or treat it medically to control the excess cortisol, which is very detrimental to the body, is great -- potentially life-saving. There are lots and lots of success stories and making differences in people’s lives. That’s why I love endocrinology.”