On April 18, 2022, the Innovative Diagnosis and Treatment Center for Pituitary Diseases (hereinafter referred to as the Pituitary Center) was officially inaugurated. This “disease-centered” discipline cluster adopts a full range of innovative service models, including joint outpatient clinic, multidisciplinary team (MDT) and combined surgery. Through integrating high-quality medical resources and optimizing the multi-disciplinary collaborative diagnosis and treatment process, the Pituitary Center can increase efficiency of healthcare provision, diversify services offered and improve patients’ satisfaction to a greater extent.
“On the day of the inauguration of the Pituitary Center, we worked with the Department of Otolaryngology, the Department of Anesthesiology and other specialties to perform a combined operation lasting more than 7 hours for a patient with malignant transformation of nasal inverted papilloma combined with growth hormone-secreting pituitary adenoma,” said chief physician Yao Yong, Director of the Pituitary Center, who added that this case was rare even in his whole career.
The patient is 59 years old this year. Lyu Wei, chief physician of the Department of Otolaryngology, found that the patient’s right nasal cavity and sinus were full of tumors, which bled repeatedly, damaged the bone at the base of the anterior skull and broke through the bone of the maxillofacial region to reach the subcutaneous soft tissue. Based on this and the biopsy results of another hospital, the diagnosis arrived at was “malignant transformation of nasal inverted papilloma”. In addition, the patient was found to have growth hormone-secreting pituitary adenoma due to “acromegaly” more than 40 years ago. He had underlying diseases such as hypertension, severe sleep apnea syndrome with severe hypoxemia, moderate to severe chronic obstructive pulmonary disease, lower extremity venous thrombosis, and severe microcytic hypochromic anemia. Due to the complicated conditions, the Department of Otolaryngology initiated multidisciplinary consultations with the Pituitary Center, the Department of Anesthesiology, Respiratory and Critical and Intensive Care, Vascular Surgery, General Surgery and Cardiac Surgery, etc.
Experts reached a consensus after discussion: surgery is the best solution at present. However, if the Department of Otolaryngology performs surgery first, it will lead to nasal adhesions and disorganized structure after surgery, and may cause the patient to miss the best timing for the pituitary tumor surgery, or even miss the opportunity for surgery. “Let’s do this! We can operate on him together,” Yao Yong called the shots during the consultation.
Despite adequate preoperative preparation, difficulties still abounded. Upon admission, the patient was already severely anemic. During the period, the nasal tumor continued to ooze blood. Only after a continuous transfusion of 6 units of red blood cells did his hemoglobin level reach the lower limit of moderate anemia, a prerequisite for surgery. On the day of the operation, the Department of Otolaryngology needed to perform a transnasal incision of the right nasal skull base under general anesthesia to remove the tumor, that is, an “open” skull base surgery, while the pituitary surgery required transsphenoidal resection under the nasal endoscope. Having different requirements for the surgical site, the two surgery teams had to operate in succession like in a relay. When the Department of Otolaryngology completed the first operation, due to the large surgical trauma and heavy bleeding, the “track” was already very “mottled”. Thus, the second surgery team of Yao Yong and Lyu Wei had to proceed tentatively and cautiously. Working carefully with each other, they finally arrived at the “finishing line” and removed the lesion. The patient has been discharged in a good shape.
If the traditional diagnosis and treatment model is like fighting a “loosely organized” battle, then the establishment of the Pituitary Center will promote the “coordinated” model. The Department of Neurosurgery, Endocrinology and Radiology are permanent members of the Pituitary Center, and other departments can be temporary members that join them. At present, the Pituitary Center has sorted out the diagnosis and treatment procedures for different pituitary diseases, built a standardized diagnosis and treatment system, and carried out a number of clinical cohort studies.
The joint pituitary clinic is another multidisciplinary model that has been adopted by the Pituitary Center. “Judging from the current symptoms and examination results, Dr. Deng and I both believe that what the kid has is pituitary hyperplasia during adolescence, not pituitary tumor.” This is the diagnosis of Zhu Huijuan, executive deputy director of the Department of Endocrinology, and Deng Kan, deputy chief physician of the Department of Neurosurgery during their consultation in the joint pituitary outpatient clinic on April 22.
When people make an appointment through the PUMCH app, they can find the joint pituitary outpatient clinic on the drop-down menu of both the Department of Surgery and the Department of Endocrinology. After registration, the patient will be diagnosed by the related department in a professional and standardized manner in one medical service zone. The Pituitary Center provides patients with not only more personalized and targeted treatment, but also follow-up, rehabilitation and other medical services. At present, the joint clinic of the Pituitary Center receives patients every Friday afternoon. In the future, the joint clinic will open for longer time every week and will enable patients with complex, difficult and critical diseases to make an appointment.
The multidisciplinary team model for pituitary diseases is long-established in PUMCH. On the basis of this, the Pituitary Center will further expand the scope of diagnosis and treatment, effectively promoting the specialization of pituitary disease diagnosis and treatment, whole-process services and intelligent management. Through carrying out multi-center prospective clinical trials, the Pituitary Center will fill the gaps in clinical studies on pituitary diseases in China, build a standardized pituitary disease database and biobank to support basic translational research, and explore the standardization of pituitary hormone testing nationwide. It will also tap the advantages of multidisciplinary teams and mobilize them to make breakthroughs in the early warning and treatment strategies for refractory pituitary diseases and contribute to the diagnosis of rare pituitary diseases, playing a demonstrative and leading role as a “pioneer”.
The Innovative Diagnosis and Treatment Center for Pituitary Diseases widens the scope of diagnosis and treatment defined by the pituitary MDT. The picture is a group photo of major team members of the center.
Reporter: Wang Jingxia
Correspondents: Yang Ruizhe and Deng Kan
Picture courtesy: The Pituitary Center
Translator: Liu Haiyan
Editor: Liu Xingrong and Wang Yao