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Pituitary Disorders CE/CME ACCREDITED Watch Time: 34 mins

touchMDT Multidisciplinary insights for Cushing’s disease: Individualized medical management of patients for whom surgery is not an option or not curative

Hear multidisciplinary team and patient insights on the medical management of Cushing’s disease.

 Overview & Learning Objectives

Patient with Cushing’s disease for whom surgery is not an option or not curative

Pituitary Surgeon, Endocrinologist & Patient/Patient Advocate
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Goals of medical therapy in CD Dr Timothy Smith, Dr Laurence Katznelson, Ms Sharmyn McGraw

A pituitary surgeon, endocrinologist and a patient/patient advocate with CD discuss key challenges in the management of CD and outline treatment goals.

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Endocrinologist, Pituitary Surgeon & Pituitary Nurse Specialist
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Medical therapies for treating CD Dr Laurence Katznelson, Dr Timothy Smith, Mrs Sandra Ramsburg

An endocrinologist, pituitary surgeon and pituitary nurse specialist discuss the treatment pathways for patients with CD, with a particular focus on medical management.

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Endocrinologist, Pituitary Surgeon, Pituitary Nurse Specialist & Patient/Patient Advocate
Watch Video
Optimizing patient outcomes in CD Dr Laurence Katznelson, Dr Timothy Smith, Mrs Sandra Ramsburg, Ms Sharmyn McGraw

An endocrinologist, pituitary surgeon, pituitary nurse specialist and patient/patient advocate discuss how patients with CD can be optimally supported in the MDT setting.

Watch Video
Pituitary Surgeon, Endocrinologist & Patient/Patient Advocate

A pituitary surgeon, endocrinologist and a patient/patient advocate with CD discuss key challenges in the management of CD and outline treatment goals.
Expert Spotlight
Dr Timothy Smith
Brigham and Women’s Hospital, Boston, MA, USA
Dr Laurence Katznelson
Stanford School of Medicine, Stanford, CA, USA
Ms Sharmyn McGraw
Orange County, CA, USA

Dr Timothy Smith, Dr Laurence Katznelson and Ms Sharmyn McGraw discuss challenges in the management of Cushing’s disease, including symptoms, diagnostic delay and associated comorbidities, and outline treatment goals for medical management.

Listen on the Go

 Learn More Back to MDT Hub Time: 11:51
 
Endocrinologist, Pituitary Surgeon & Pituitary Nurse Specialist

An endocrinologist, pituitary surgeon and pituitary nurse specialist discuss the treatment pathways for patients with CD, with a particular focus on medical management.
Expert Spotlight
Dr Laurence Katznelson
Stanford School of Medicine, Stanford, CA, USA
Dr Timothy Smith
Brigham and Women’s Hospital, Boston, MA, USA
Mrs Sandra Ramsburg
Johns Hopkins Hospital, Baltimore, MD, USA

Dr Laurence Katznelson, Dr Timothy Smith and Mrs Sandra Ramsburg discuss the medical treatment pathways for patients with CD, with a particular focus on medical management, including insights on the efficacy and safety of approved agents, as well as other considerations for clinical practice.

Listen on the Go

 Learn More Back to MDT Hub Time: 11:33
 
Endocrinologist, Pituitary Surgeon, Pituitary Nurse Specialist & Patient/Patient Advocate

An endocrinologist, pituitary surgeon, pituitary nurse specialist and patient/patient advocate discuss how patients with CD can be optimally supported in the MDT setting.
Expert Spotlight
Dr Laurence Katznelson
Stanford School of Medicine, Stanford, CA, USA
Dr Timothy Smith
Brigham and Women’s Hospital, Boston, MA, USA
Mrs Sandra Ramsburg
Johns Hopkins Hospital, Baltimore, MD, USA
Ms Sharmyn McGraw
Orange County, CA, USA

Ms Sharmyn McGraw, a patient with CD in remission for 23 years and patient advocate, joins endocrinologist Dr Laurence Katznelson, pituitary surgeon Dr Timothy Smith and pituitary nurse specialist Mrs Sandra Ramsburg to discuss how the MDT can support patients with CD.

Listen on the Go

 Learn More Back to MDT Hub Time: 10:20
 
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Overview & Learning Objectives
Overview

In this activity, three experts involved in the management of patients with Cushing’s disease (CD), plus a patient and patient advocate in remission with CD, share their perspectives of CD, with a focus on the role of individualized medical management and optimizing patient outcomes in the multidisciplinary team (MDT) setting.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of endocrinology healthcare professionals, neurosurgeons, primary care physicians, nurse practitioners and pharmacists involved in the management of Cushing’s disease, with a focus on the USA.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Laurence Katznelson discloses: Advisory board or panel fees from Recordati and Strongbridge Biopharma.

Dr Timothy Smith has no financial interests/relationships or affiliations in relation to this activity.

Mrs Sandra Ramsburg has no financial interests/relationships or affiliations in relation to this activity.

Ms Sharmyn McGraw has no financial interests/relationships or affiliations in relation to this activity.

Content reviewer

Alicia Canalejo, MSN, APRN-C, has no financial interests/relationships or affiliations in relation to this activity.

Christy Thai, PharmD, BCPS, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Christina Mackins-Crabtree and Sadaf Kazi have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Pharmacists

USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for 0.75 contact hours (0.75 CEUs). Universal program number is as follows: 0230-9999-23-007-H01-P.

Date of original release: 30 March 2023. Date credits expire: 30 March 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Outline the clinical importance of treating Cushing’s disease and the role of medical management in achieving treatment goals
  • Evaluate the clinical data supporting currently approved and emerging medical therapies for Cushing’s disease
  • Discuss strategies to individualize therapy in patients with Cushing’s disease using a multidisciplinary team approach to optimize patient outcomes
Downloads

View and download resources from this activity to support your learning and share with colleagues

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Faculty & Disclosures
Dr Laurence Katznelson

Stanford School of Medicine, Stanford, CA, USA

Dr Laurence Katznelson is a professor of neurosurgery and medicine at the Stanford University School of Medicine, CA, USA. He is the associate dean of Graduate Medical Education (GME) and the chair of the GME Committee at Stanford University, where he also previously served as the endocrinology fellowship programme director. Dr Katznelson is the medical director of the Pituitary Center at Stanford. read more

Dr Laurence Katznelson received his medical degree from the University of California, Los Angeles, CA, and completed his internship and residency in internal medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA. He undertook his fellowship in endocrinology and metabolism at the Massachusetts General Hospital, Boston, MA, and then stayed on as faculty in the Neuroendocrine Unit.

Dr Katznelson serves as the president-elect of the Pituitary Society. He received the H Jack Baskin Endocrine Teaching Award from the American Association of Clinical Endocrinologists in 2015 and the Laureate Outstanding Educator Award from the Endocrine Society in 2017. Dr Katznelson has a long-standing research interest in education and pituitary disease, including hypopituitarism and the pathophysiology and therapy of pituitary tumours.

Dr Laurence Katznelson discloses: Advisory board or panel fees from Recordati and Strongbridge Biopharma.
Dr Timothy Smith

Brigham and Women’s Hospital, Boston, MA, USA

Dr Timothy Smith is director of the Computational Neuroscience Outcomes Center (CNOC) in the Department of Neurosurgery at Brigham and Women’s Hospital, Boston, MA, USA. read more

Dr Smith is a neurosurgeon–scientist who seeks to understand, predict and improve clinical outcomes for neurosurgical patients by combining the use of epidemiological data, advanced statistical analysis, machine learning and emerging biological/information system technologies. As an epidemiologist and statistician in addition to his neurosurgical residency, he focuses primarily on the utilization of data science to optimize neurosurgical patient care.

Dr Smith’s clinical interests focus on tumours of the brain and spine that arise innately from the central nervous system and meningeal covering of the brain, or metastasize from other primary cancer sites.

Dr Smith plays an active role in the Brigham and Women’s Hospital’s neurosurgical residency programme. He is a committee vice-chair for medical-legal issues with the Council of State Neurosurgical Societies (CSNS) as well as the president of the Boston Society for Neurology, Neurosurgery, and Psychiatry, the oldest academic neuroscience society in the USA. He serves on numerous committees in the USA and worldwide that focus on the ethics of neurosurgery, oncology, skull base surgery and neurologic outcomes assessment. He is an active member of committees at Brigham and Women’s Hospital addressing information technology, physician wellness and process improvement.

Dr Smith maintains active membership in national and international neurosurgical societies, including the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the North American Skull Base Society, the Society for Neuro-Oncology and the Pituitary Society. He presents his research regularly at national and international meetings. He has published over 150 peer-reviewed journal articles and several book chapters.

Dr Timothy Smith has no financial interests/relationships or affiliations in relation to this activity.
Mrs Sandra Ramsburg

Johns Hopkins Hospital, Baltimore, MD, USA

Sandra Ramsburg is the nurse coordinator of the Pituitary Center at The Johns Hopkins Hospital, Baltimore, MD, USA. She works closely with the medical director to review patients’ medical information and evaluate and anticipate their needs for endocrinology, neurosurgery and neuro-ophthalmology appointments. She also provides patients with vital discharge counselling after pituitary surgery to communicate expectations and to address any issues or concerns.

Mrs Sandra Ramsburg has no financial interests/relationships or affiliations in relation to this activity.
Ms Sharmyn McGraw

Orange County, CA, USA

Ms Sharmyn McGraw is a pituitary patient advocate, and the Pituitary Patient Support Group facilitator at the Pacific Neuroscience Institute, Santa Monica, CA, USA. She has taken part and volunteered as an organizer and facilitator at many neuroendocrine and neurosurgery educational conferences, as well as neurosurgery, endoscopic, cadaver courses and live surgery training.

Ms Sharmyn McGraw has no financial interests/relationships or affiliations in relation to this activity.
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This Activity Is Funded By:

An independent medical education grant from Recordati Rare Diseases and Xeris Pharmaceuticals, Inc. This activity is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 30 March 2023. Date credits expire: 30 March 2024.

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Question 1/5
Your 41-year-old male patient is about to initiate medical therapy for the treatment of Cushing’s disease. How do you explain what the primary goal of their medical treatment is?
 Correct

The primary goal of medical management for patients with Cushing’s disease is to normalize cortisol levels (or cortisol action if using mifepristone) as quickly as possible.

Reference

Fleseriu M, et al. Lancet Diabetes Endocrinol. 2021;9:847–75.

Question 2/5
Your 34-year-old female patient has been diagnosed with Cushing’s disease resulting from a pituitary adenoma. You explain that surgery is typically the first-line approach to treatment, and your recommendation is to operate. Your patient is apprehensive and asks if there is a drug she can take instead. What would you do?
 Correct

The Pituitary Society 2021 recommendations state that pituitary surgery is recommended as first-line therapy for patients with Cushing’s disease. However, drugs can be used for the following patients:

  • Those with persistent or recurrent Cushing’s disease following surgery
  • Those who are not candidates for, or refuse to have, surgery
  • Those requiring control of cortisol concentrations while undergoing radiotherapy

Reference

Fleseriu M, et al. Lancet Diabetes Endocrinol. 2021;9:847–75.

Question 3/5
Which of the following best describes the mechanism of action for levoketoconazole?
 Correct

Levoketoconazole is an adrenal steroidogenesis inhibitor.

Reference

Favero V, et al. Int J Mol Sci. 2021;22:11521.

Question 4/5
Your 44-year-old female patient has Cushing’s disease that requires medical treatment due to an unsuccessful pituitary surgery. You propose initiating treatment with osilodrostat. What information would you give to your patient about the potential challenges associated with osilodrostat treatment?
 Correct

Fatigue, nausea and headache are among the most common adverse events (incidence >30%) associated with osilodrostat; however, mild to moderate hirsutism or acne have been reported in female patients (12% and 11%, respectively).

Reference

FDA. Osilodrostat PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2020/212801s000lbl.pdf (accessed 24 February 2023).

Question 5/5
Which of the following statements is true regarding use of FDA-approved medical treatments for Cushing’s disease during pregnancy?

FDA, United States Food and Drug Administration.
 Correct

No medications for the treatment of Cushing’s disease are FDA-approved specifically for use in pregnancy.1,2 Mifepristone results in pregnancy termination and mitotane specifically can cause foetal harm.2 For levoketoconazole, osilodrostat, and pasireotide, there are insufficient data on use in pregnant women to evaluate for a drug-associated risk of major birth defects and miscarriage.2

Abbreviation

FDA, United States Food and Drug Administration.

References

  1. Fleseriu M, et al. Lancet Diabetes Endocrinol. 2021;9:847–75.
  2. FDA. Individual drug PIs. Available at: www.accessdata.fda.gov/scripts/cder/daf/index.cfm (accessed 25 January 2023).
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