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2016 ; 101
(3
): 769-77
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Pituitary Medicine From Discovery to Patient-Focused Outcomes
#MMPMID26908107
Melmed S
J Clin Endocrinol Metab
2016[Mar]; 101
(3
): 769-77
PMID26908107
show ga
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.