Ms. Liu from Urumqi, Xinjiang was an advanced-age pregnant woman who was facing labor induction due to pituitary macroadenoma. It was the prompt treatment of the multidisciplinary team for difficult and complicated hypothalamic-pituitary cases (pituitary MDT) at PUMCH that brought to her the hope of life.
Four years ago, Ms. Liu began to experience abnormal menstruation and even amenorrhea, making it hard to conceive. When she finally got pregnant with assisted reproductive technology in a local hospital, she developed symptoms of headache and obvious vision decline in both eyes at the 26th week of pregnancy. Then she went to the local hospital, and a pituitary macroadenoma with a diameter of 3.3cm was found in the sellar region, which compressed the optic nerve. The treatment of the pituitary macroadenoma was complicated with more unpredictable risks from pregnancy, so the local hospital proposed remote consultation to the pituitary MDT at PUMCH. Zhu Huijuan, Chief Physician of the Department of Endocrinology, and Yao Yong, Chief Physician of the pituitary professional team at the Department of Neurosurgery, attended the consultation and determined the root cause of Ms. Liu’s headache and vision decline as hemorrhagic stroke in part of the pituitary macroadenoma. The patient’s pituitary macroadenoma had exceeded 3cm in diameter, accompanied by acromegaly caused by excessive growth hormone secretion, and the tumor hemorrhage may worsen during pregnancy, leading to further vision decline or even blindness. Considering the above factors, the PUMCH experts present at the remote consultation offered targeted treatment recommendations, that is early resection of the pituitary macroadenoma through endoscopic endonasal transsphenoidal surgery to reduce the compression on the optic nerve.
To ensure the patient’s safety, the local hospital proposed labor induction before surgery, but Ms. Liu and her husband held dear this hard-won fetus in the womb. Facing such dilemma, Ms. Liu came to PUMCH thousands of miles away from her home for a gleam of hope. The experts of the pituitary MDT knew that they were not only responsible for curing the disease, but also igniting the patient’s hope for life. The Department of Ophthalmology designated doctors to check Ms. Liu’s vision and visual field once a week; each team in the pituitary MDT was ready for responding to emergencies and performing emergency operation at any time based on the patient’s conditions; the Department of Obstetrics and Gynecology designated doctors for Ms. Liu; and the Department of Anesthesiology opened green channel to her. The detailed emergency plan for multidisciplinary collaboration was formulated. On October 7, under close monitoring of the pituitary MDT, Ms. Liu’s gestational period finally reached 30 weeks. According to the pre-determined treatment plan, the patient was first transferred to the Department of Neurosurgery, and the obstetricians monitored the fetal heart rate every morning and evening. Following a joint assessment by all departments of the pituitary MDT and full preoperative preparation, Ms. Liu was wheeled into the operating room on October 11. The pituitary macroadenoma was completely resected in the over-one-hour operation, and Ms. Liu and her fetus were both safe. With the growth hormone decreasing from 17.4ng/ml before operation to 0.9ng/ml after operation, Ms. Liu was clinically cured.
A series of core systems, such as multidisciplinary consultations, grand rounds and clinical pathological conferences, have been established since the founding of PUMCH, which help ensure the high-quality clinical diagnosis and treatment at PUMCH. The hospital has extended the effective MDT to outpatient clinics and established a consultation center for difficult and complicated cases in 2010, with 29 professional groups successively set up in pancreas, rare diseases, pituitary, lateral skull base tumors, and metabolic bone diseases and so on, to provide “one-stop” diagnosis and treatment for patients with difficult, complicated, severe and rare diseases. This marks a shift from a “doctored-centered” approach to a “patient-centered” one.
Chief Physician Yao Yong received the message of “good news” from the patient, saying “Professor Yao, this is my boy. He is 3.3 kilograms but I didn’t put on much weight. The baby is healthy and thank you for your care.”
Reporter: Wang Jingxia
Picture: Pituitary MDT
Translator: Liu Haiyan
Editor: Wang Yu