A Decade of the Massachusetts General Hospital Neuroendocrine Clinical Center

In 1985, the Massachusetts General Hospital Neuroendocrine Clinical Center was founded to provide a multidisciplinary approach to patients with pituitary and hypothalamic disorders. The Center was developed because of the recognition that there was fragmentation of care for patients undergoing medical treatment, surgery, or radiation therapy for pituitary and hypothalamic disorders. Although there were independent areas of expertise in neurosurgery, neuroendocrinology, radiation oncology, and neurology at the Massachusetts General Hospital as well as neuroophthalmologists at the adjacent Massachusetts Eye and Infirmary, there was no coordinated program of specialty services to provide an integrated approach to patients. In addition, it was clear that innovative clinical research programs exploring the pathogenesis and treatment of pituitary disease would be facilitated by centralized patient services and a broad referral base. A partnership was, therefore, formed with neurologists and neurosurgeons who coordinated their schedules to provide a weekly unified day for out-patient consultations and multidisciplinary case reviews. Links were also established with radiation oncology for patients needing radiation therapy for sellar or hypothalamic masses, with neuroophthalmology to provide access to detailed evaluation for optic chiasm compression or involvement of the cranial nerves in the cavernous sinus, and with neuropathology and neuroradiology to coordinate access to state of the art diagnostic techniques. A major advantage for patients, particularly those traveling from other states or countries, was the coordination of consultations by all these services into a 24to 48-h period. Experienced neuroendocrine nursing was also incorporated to provide better patient monitoring and teaching. The three major objectives of the new Center were 1) excellence in patient care, 2) establishment of a patient base for innovative clinical research studies, and 3) professional and patient education. A weekly interdisciplinary Neuroendocrine Case Conference was established as the cornerstone of coordinated patient care and physician education. This was to provide a forum for staff neuroendocrinologists, neurosurgeons, neurologists, and radiation oncologists to reach a multidisciplinary consensus for a diagnostic and therapeutic plan for each patient seen that week in the Center. Local primary care providers, endocrinologists, fellows, residents, and medical students were also invited to participate in these conferences. An office suite was designed that included patient consultation rooms, the Pituitary Test Center for performing dynamic hormone tests on site, and a conference room for formal case review. Since its founding in 1985, the Neuroendocrine Clinical Center has grown substantially in patient volume and personnel to become a major national and international referral center for patients with pituitary and hypothalamic disorders. Initially staffed by 1 endocrinologist, 1 neurologist, and 1 neurosurgeon on 1 afternoon a week, it now is comprised of 3 weekly teaching sessions with a total of 7 endocrine fellows as well as rotating medicine and neurology residents and medical students seeing patients under supervision by 4 staff neuroendocrinologists, 1 neurologist, and 2 neurosurgeons. There are also several separate weekly staff sessions. The total volume at the inception of the Clinical Center was approximately 100 patient visits/yr; it is now well over 1000 visits annually. The most consistent reason for growth of the Center is that referring physicians believe that this type of cohesive multidisciplinary program is needed for patients with complex pituitary and hypothalamic diseases. Despite the fact that many patients come from other states or countries, permission for out of plan coverage is often obtained from insurance carriers because of the unique strengths of the Center. Many patients are referred because of the specific expertise of individual staff endocrinologists in areas such as prolactinomas, Cushing’s disease, and acromegaly. Referrals are also directed toward the expertise of the neurosurgeons, who are world-renowned for their abilities at curative transsphenoidal adenomectomy with minimal morbidity. With well over 1000 transsphenoidal surgeries performed at Massachusetts General Hospital over the past 15 yr currently undergoing analysis, it is clear that the many years of experience are beneficial to patients. In addition, one of the world’s largest experiences with stereotactic radiosurgery using proton beam therapy for residual/recurrent pituitary Received November 6, 1996. Accepted January 10, 1997. Address all correspondence and requests for reprints to: Beverly M. K. Biller, M.D., Neuroendocrine Unit, BUL457B, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114-2696. 0021-972X/97/$03.00/0 Vol. 82, No. 6 Journal of Clinical Endocrinology and Metabolism Printed in U.S.A. Copyright © 1997 by The Endocrine Society