Pituitary Services For Healthcare Professionals

Dr. Maria Fleseriu

We value our partnerships with community physicians and other health care professionals. We work closely with you to make decisions and create care plans for your patients.

As part of a large academic health system, we are your regional resource for multidisciplinary pituitary care.

We created a helpful guide on pituitary disorders. View the OHSU pituitary disorders guide.

Your patient’s first visit with us

Our clinic is conveniently located at the OHSU Center for Health & Healing in the South Waterfront District, at the foot of the Portland Aerial Tram and offers ample parking (free to patients).

First visits include consultations with an endocrinologist and, if appropriate, a neurosurgeon. If dynamic testing is required, we will schedule that for the same day. If your patient needs a more extensive evaluation, we will schedule that in advance.

Our interdisciplinary team reviews

After your patient’s first visit, our endocrinologist and neurosurgeon quickly review initial laboratory and imaging results. Next, we contact you to discuss possible treatment plans, which may include clinical trials.

Treatment implementation

Any follow-up visits will be coordinated so your patient’s appointments happen on a single day. We’ll keep you updated on recommended next steps.

Patient follow-up

After initial treatment, we will follow up with your patient once a week for six weeks. We’ll arrange for additional laboratory tests as needed. Your patient will also receive a written treatment plan. We give your patient information about whom to call with questions, and we are always available for your questions or further consultation.

Follow your patient's care on OHSU Connect

Refer a patient

Pituitary Center booklet

Most of the information on this website is also available in booklet form. View the OHSU Pituitary Center booklet

Research publications

The OHSU Pituitary Center team’s work has been published in many well-regarded peer-reviewed journals, including The Lancet, Diabetes & Endocrinology, Journal of Clinical Endocrinology and Metabolism, Pituitary, Journal of Neurosurgery, Neurosurgery, European Journal of Endocrinology, Journal of Molecular Endocrinology and Endocrine. The team’s contributions to medical literature are highly cited, reaching over 239 citations in additional journals for one manuscript. We also contributed to several international diagnostic guidelines for the treatment of pituitary tumors and dysfunction.

Maria Fleseriu, M.D., F.A.C.E., has over 100 manuscripts and chapter book publications in the last five years and other team members have published extensively as well. View list of publications.

Test your clinical skills

These clinical case examples are geared toward the general practitioner and exemplify the multifaceted and complex issues in diagnosing and treating pituitary disease patients.

A previously healthy 50-year-old male presents to your office with several new complaints. About three months earlier he had been given the diagnosis of Raynaud's phenomenon due to cold intolerance particularly affecting his hands. Over the past month, he has been fatigued and has generalized cramping and achiness. On further questioning, he also thinks he has lost some hair on his hands, has been having difficulty concentrating and has had some loss of libido. He has no constipation, abdominal discomfort, orthostasis, headaches or visual problems. He has been told that many of his symptoms are consistent with depression possibly related to the stress of being diagnosed with Raynaud's phenomenon as well as problems at work. His physical exam is unremarkable (weight is 100 kg). His CBC, metabolic panel, and sedimentation rate are all normal but his free T4 is low at 0.48 (nl 0.8 - 1.8) with a normal TSH of 1.58 (nl 0.38 - 4.70).

Of the following choices, what would your next step be?

  1. Assure the patient that the normal TSH confirms his thyroid function is adequate and that some normal people have lower than "normal" free T4 levels due to population variance.
  2. Start the patient on thyroid hormone replacement and refer him for the next available endocrinology appointment for evaluation of possible central hypothyroidism.
  3. Start the patient on thyroid hormone replacement (175 mcg qd based on his weight) and hydrocortisone (20 mg q a.m.). You repeat the TSH and free T4 and order the other labs as described in The Basic Pituitary Disease/Pituitary Tumor Work-up including a head MRI (with and without gadolinium). Refer the patient to a neuroendocrinologist to set up further endocrine testing and management.

C

A 45-year-old man transfers care to you two months after a 1.75-cm pituitary lesion has been discovered as part of a workup for intractable headaches (progressively worsening over the past two years). He has no signs or symptoms of other pituitary dysfunction or visual field disturbances. Past medical history and review of symptoms is negative. He has been on a low dose of a dopamine agonist for the past two months. You perform labs that reveal a normal chemistry panel and CBC, and normal pituitary workup as described in The Basic Pituitary Disease/Pituitary Tumor Workup. However, you note that two months ago, the patient's prolactin level was significantly elevated at 75 ng/ml (normal 3-29). This has now normalized after two months of dopamine agonist treatment. The MRI from two months ago reveals a 1.75-cm noncystic pituitary lesion displacing but not splaying the optic chiasm.

Of the following choices, what would your next step be?

  1. Stay the course. The clinician that started dopamine agonist therapy had excellent instincts. The fact that the prolactin level returned to normal confirms that this is a tumor sensitive to dopamine agonist therapy. The tumor will substantially shrink in the months ahead.
  2. Schedule this patient to see a neurosurgeon because this pituitary lesion is not a prolactinoma and needs to be removed!
  3. Be cautious but don't overreact. Since the prolactin level normalized relatively quickly, it would be prudent to re-image the lesion in six months to confirm that it has decreased in size. Surgery would be indicated only if the lesion continues to grow despite dopamine agonist therapy.

B

A 55-year-old man presents to your office one year after transphenoidal resection of a 2.0 cm pituitary lesion that had caused significant preoperative pituitary destruction (biochemically proven). Acromegaly and Cushing's disease were adequately ruled out preoperatively. His peripheral vision has now returned to normal but he continues to "not feel normal" despite pituitary hormone replacement. His main complaints are memory loss, diminished vigor and social isolation. He is noticing mild central obesity. He denies temperature dysregulation, constipation or diarrhea, nausea or abdominal discomfort, orthostasis, decreased libido or decreased sexual function. His current medications include levothyroxine (150 mcg/day), hydrocortisone (20 mg q a.m.), and testosterone (7.5 g gel per day). You perform laboratory testing which reveals a normal basic metabolic panel and CBC. His testosterone level is 515 ng/dl (normal 270-1070) and free T4 is 1.2 (normal 0.7-1.8). His one year post-op MRI reveals no residual pituitary tumor.

Of the following choices, what would your next step be?

  1. Explain to the patient that these symptoms are not related to his history of pituitary problems. Since he has had all his significant pituitary hormones optimally replaced as reflected by the his lack of symptoms and normal laboratory testing, discuss with him other non-pituitary causes of his symptoms such as depression, etc.
  2. Work to maximize his thyroid, cortisol and testosterone dosing. As you do so, many of these symptoms may resolve.
  3. Consider adding growth hormone (GH) replacement in this patient.

C