Pituitary Medicine From Discovery to Patient-Focused Outcomes

Abstract

Context: This perspective traces a pipeline of discovery in pituitary medicine over the past 75 years.

Objective: To place in context past advances and predict future changes in understanding pituitary pathophysiology and clinical care.

Design: Author's perspective on reports of pituitary advances in the published literature.

Setting: Clinical and translational Endocrinology.

Outcomes: Discovery of the hypothalamic-pituitary axis and mechanisms for pituitary control, have culminated in exquisite understanding of anterior pituitary cell function and dysfunction. Challenges facing the discipline include fundamental understanding of pituitary adenoma pathogenesis leading to more effective treatments of inexorably growing and debilitating hormone secreting pituitary tumors as well as medical management of non-secreting pituitary adenomas. Newly emerging pituitary syndromes include those associated with immune-targeted cancer therapies and head trauma.

Conclusions: Novel diagnostic techniques including imaging genomic, proteomic, and biochemical analyses will yield further knowledge to enable diagnosis of heretofore cryptic syndromes, as well as sub classifications of pituitary syndromes for personalized treatment approaches. Cost effective personalized approaches to precision therapy must demonstrate value, and will be empowered by multidisciplinary approaches to integrating complex subcellular information to identify therapeutic targets for enabling maximal outcomes. These goals will be challenging to attain given the rarity of pituitary disorders and the difficulty in conducting appropriately powered prospective trials.

Figure 1.

Cascade of pituitary tumorigenesis. Pituitary hyperplasia is usually reversible, as exemplified by pregnancy. Pituitary carcinoma is exceedingly rare. (From Melmed S. Nat Rev Endocrinol 2011;7:257–266.).

Figure 2.

A personalized predictive approach to nonfamilial pituitary tumor management.