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Research Week 2018: Small gland, big impact

Physician uses basic science research to improve treatment of pituitary conditions
patient and doctor, talking in exam room
Jessica Fisher (left) meets with Maria Fleseriu, M.D., in April 2018. Fleseriu's work as an endocrinologist focuses on the pituitary gland, the small organ that produces hormones that regulate growth, sleep, lactation, reproduction and metabolism. (OHSU/Kristyna Wentz-Graff)

Today, Maria Fleseriu, M.D., is a world-renowned endocrinologist. Yet as a sixth-grader growing up in Romania, she aspired to become a cardiologist. In fact, she vividly recalls etching the diagram of a working heart on the windows in her childhood home.

“My mom was not happy,” she said with a chuckle. “But now she says it was well worth it.”

Fleseriu’s career took her from Romania where she was an endocrinologist focused on the pituitary gland, to a visiting internship at Harvard Medical School, a residency at Case Western Reserve University, a fellowship at the Cleveland Clinic and finally to OHSU, where she arrived in 2006 to join the Northwest Pituitary Center. Today, she is the center’s director and a professor of medicine (endocrinology, diabetes and clinical nutrition) in the OHSU School of Medicine.

Recently elected president of The Pituitary Society, the world’s largest professional society focused on the pituitary gland, few physicians can rival Fleseriu’s depth of knowledge about the so-called master gland that regulates hormones throughout the body – affecting everything from reproduction to sleep.

Her early interest in the heart transitioned to a fascination with the pituitary gland.

doctor examining legs of patient
OHSU's Northwest Pituitary Center has a research focus and sees over 1,500 patients a year. Patients like Jessica Fisher (left), can participate in clinical trials. Studies from the center have led to the first two FDA-approved medications for Cushing’s syndrome and in new treatment options for acromegaly. (OHSU/Kristyna Wentz-Graff)

The pea-sized gland has an outsized importance in human health and well-being. This small organ controls the collection of glands producing hormones that regulate growth, lactation, sleep, reproduction and metabolism. Fleseriu was mesmerized.

“For such a small gland, it coordinates almost all the other glands in the body and it’s linked to the brain,” she said. “I was hooked.”

Fleseriu leads a center that cares for more than 1,500 patients a year – more than any other center on the West Coast. A multidisciplinary team of specialists delivers treatment ranging from monitoring to surgery, medication or radiation along with follow-up monitoring and care. Once thought to be rare, small pituitary tumors can be spotted in as many as one in four people thanks to increasingly sophisticated imaging techniques. Because many of those tumors are not well-known, research is a bedrock of the OHSU center.

To understand the disease, the team’s research includes basic laboratory science.

“We’ll look at the disease at the molecular level,” she said.

For patients, the research focus means they have the chance to take part in clinical trials testing the cutting edge of clinical care for pituitary conditions like Cushing’s syndrome or acromegaly.

“Patients like the option to participate in new treatments,” Fleseriu said. “Our patients at OHSU have played a major role in the studies leading to the first two FDA-approved medications for Cushing’s syndrome and in new treatment options for acromegaly.”

doctor looking at brain scan on computer
As the science and understanding of the pituitary gland improves, Fleseriu sees the opportunity to diagnosis pituitary conditions sooner, potentially through prescreening based on a person’s genetic history. (OHSU/Kristyna Wentz-Graff)

Because much remains to be learned about the endocrine system, basic molecular science can lead directly to clinical trials conducted at OHSU. Fleseriu credits an OHSU culture that encourages coordination between different kinds of specialists and researchers, with the goal of taking science from “bench to bedside” to benefit patients today.

“I envision that clinical care would be even more closely linked to the research,” Fleseriu said.

As the science and understanding of the pituitary gland improves, Fleseriu sees the opportunity to diagnosis pituitary conditions sooner, potentially through prescreening based on a person’s genetic history. Early treatment could lower complications and decrease the need for intensive therapies like multiple rounds of medication or surgery.

Fleseriu is excited by the opportunity to advance the science; in fact, her enthusiasm for science is just as strong today as it was as a sixth-grader diagramming a heart on the window of her childhood home.

Fleseriu’s daughter is a college freshman studying to be a physician so the passion for learning, medicine and science now extends across generations. Fleseriu, only the third woman elected president of The Pituitary Society, believes it’s important to encourage young women to engage in science starting in elementary school – just as she did.

“We need more women interested in science everywhere,” she said. “Once they start, they’ll see they can do it just as well as boys.”

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