Dr Maria Fleseriu is a neuroendocrinologist, she is Director of the Pituitary Centre and Professor of Medicine and Neurological Surgery at the Oregon Health and Science University in Portland, USA. Her work focuses on developing novel treatments for Cushing’s syndrome and acromegaly. Read our interview to learn more about her career path, what she loves most about her field, and a taster of her SfE BES 2022 lecture.
Tell us a little about your career path, so far?
I’ve always been fascinated with medicine. After learning how the heart’s mechanical valves and electrical system intertwined in the 6th grade, I became hooked. I would outline them on the foggy windows of my childhood home and my mum remembers how much work it was to clean the window smudges… After medical school, I trained in endocrinology in Romania, and subsequently completed another residency and then a fellowship at the Cleveland Clinic in the USA. I specialise in neuroendocrinology and currently hold two positions at the Oregon Health and Science University in Portland, USA.
Why did you choose to specialise in endocrinology?
During the first year of medical school, I became fascinated with the negative feedback system that regulates the hypothalamic-pituitary-axis. The fact that a pea-sized organ is the ultimate “master” gland intrigued me, so for my first research project I focused on improving imaging of the pituitary. This was the moment where neuroendocrinology became my passion.
Can you tell us about your current project?
My research focuses primarily on novel treatments for acromegaly and Cushing’s syndrome. I am also working to elucidate the extent and the recovery rate of pituitary dysfunction after surgical and/or other adjuvant therapies for pituitary adenomas. I have served as principal investigator or global principal investigator in multiple clinical trials studying novel chimeric molecules, new somatostatin multi-receptor ligands, adrenal steroidogenesis inhibitors, antisense oligonucleotide therapy and glucocorticoid receptor blocker use for the treatment of acromegaly or Cushing’s.
What do you love most about your work?
Although I’m no longer drawing on windows, I still get very excited about hormonal feedback! As the science and understanding of the pituitary gland improves, hopefully we will be able to diagnose pituitary conditions sooner. Early treatment could reduce complications and improve patients’ outcomes and I love to share the knowledge we’ve accumulated. When I saw my first patient with a pituitary tumour, almost 3 decades ago, all we had in terms of treatment was bromocriptine. We now have several classes of medications that we can use based on a “trial and error” approach, but personalised treatment regimens are increasing. I hope we will move closer to an individualised model, similar to that used in oncology.
What are the biggest changes in managing Cushing’s syndrome?
We face challenges at all stages, diagnosis can be difficult, especially in earlier, less ‘full-blown’ cases. The phenotype that we see is shared with several other conditions, which are much more common and necessitates physicians to be more aware of this syndrome, ‘to think about it’ and screen when needed.
Localisation can sometimes be challenging and the management itself can also be complicated, although we have better treatments, they don’t always work and recurrence rate in Cushing’s disease is quite high.
Where do you see the next breakthrough happening in your field?
These are exciting times for specialists like me who have dedicated their career to the pituitary gland. Several histological and molecular markers have been developed that allow us to move translational research closer to the ‘clinic’. Physicians will soon have the right tools to predict the clinical course of pituitary adenomas more precisely and to develop individualised plans for management, also including patients’ preferences.
Could you tell us about your SfE BES 2022 lecture?
My lecture will highlight recent advances in management of Cushing’s disease, which should also consider comorbidities and complications associated that might compromise patient health and quality of life. I will discuss how treatments that specifically target certain pathways will create a paradigm shift in how we treat pituitary disorders, but WE ARE NOT THERE yet. I have great appreciation to the thousands of patients who have contributed time and energy for research studies, allowing us to better understand the aetiology and complications, and to discover new treatments for this complex disease.
Do you have any words of wisdom for future endocrinologists?
Pituitary disorders are complex and usually require a multidisciplinary approach. Every day, I communicate with a range of specialists, from neurosurgeons to gynaecologists, psychologists, and primary care physicians. While the hormones abnormalities are at the centre, they cause diverse health problems that warrant specific evaluation and management. Our mission is to educate our patients and medical community about hormones and promote innovative science – both of which will lead to better patient care. It is not easy, but it is fulfilling and rewarding.
You can attend Dr Maria Fleseriu’s Clinical Endocrinology Trust Visiting Lecture “Novel Approaches for Cushing’s Medical Management: Guidelines to Clinical Practice“ on Monday 14 November from 2 – 2:30pm.
Take a look at the full scientific programme for SfE BES 2022.