UVA Doctor Eyes Tumors of Pituitary

[Marie_LPN, RN, LPN, RN]

UVa doctor eyes tumors of pituitary

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By Sarah Barry / Daily Progress staff writer

July 10, 2005

Doctors have been removing bits of brain through the nose since the time of the ancient Egyptians. During the mummification process, a tool was inserted through a nostril and used to liquefy the brain. In similar fashion, Dr. Edward Laws at the University of Virginia is working to enhance a technique that surgically removes pituitary tumors through a patient's nose.

Pituitary tumors form at the base of the skull. They are benign, meaning they grow out of the pituitary gland but do not spread to other parts of the body. They can cause a wide array of symptoms, from blindness to impotence to fatigue, depending on the type of tumor. "Many patients who have what we would think of as ordinary complaints have pituitary tumors," Laws said.

But Laws and his partner, Dr. John Jane Jr., have begun using microscopes, endoscopes and computer-guided neuronavigation to enhance a procedure that was first developed in the 1970s. By using an endoscope, Laws is able to see the entire base of the skull on a computer screen next to the patient. By moving the endoscope back and forth, he is able to simulate a three-dimensional image. "It's made a huge difference in what we can do and what we can do safely and effectively."

Laws has treated more than 4,500 patients with pituitary tumors, which he says is the most of any doctor in the world. "He is one of the legends of neurosurgery," said Dr. Mitchel Berger, chairman of neurosurgery at the University of California-San Francisco.

What makes the program at UVa special, Laws says, and what draws people from all over the world, is the "team approach" the doctors take to treating the tumor. Patients being treated for pituitary tumors meet the endocrinologists, the pathologists and the surgeons all at once. "Patients can come in and get everything taken care of in a very efficient way," Laws said.

More than 2,000 people are diagnosed each year as having pituitary tumors, according to the American Cancer Society. But Robert Knutzen, chairman of the Pituitary Network Association, stresses that "the tumors are not rare, just rarely diagnosed."

Part of what makes a diagnosis difficult is the variety of symptoms associated with the tumors. There are seven different types of pituitary tumors, each with its own symptoms. The most commonly treated are prolactinomas, which cause a loss of sexual function in both men and women and can cause a "milky discharge" from the nipples, Laws said.

"When these problems hit the person, it affects the entire family," Knutzen said. He emphasized that the emotional side effects of the disease can outstrip the physical, as it can lead to divorce or separation.

Acromegaly can cause excess growth hormone to be produced, and Cushing's disease can result in obesity and excess body hair.

And while Laws and others like him are often able to surgically remove a tumor, Knutzen points out there are often residual problems.

"That's why I hate the term 'benign,'" Knutzen said. "It implies friendly, harmless, a pleasant creature."

Knutzen had a pituitary tumor removed 15 years ago. "I am living with some of the physical aftermaths of it and I will until the day I die."

Because of the lasting physical and emotional problems patients face, Laws is working to add a psychologist to his team of doctors. "It's often a tremendous assault on their body image," Laws said. "We want to help people deal with that and get them back to normal."

Although Knutzen wasn't treated by Laws, Knutzen's association, which he founded one year after his tumor was removed, named Laws one of its Gentle Giants for his contributions to the field. "There is only a very small worldwide community of neurosurgeons recognized as having exceptional gifts, skills, abilities in pituitary surgery," Knutzen said. "Dr. Laws is certainly the dean of that select little community."