title: Pituitary Medicine From Discovery to Patient-Focused Outcomes.
abstract: BACKGROUND
  This perspective traces a pipeline of discovery in pituitary medicine over the past 75 years.
  
  
  OBJECTIVE
  To place in context past advances and predict future changes in understanding pituitary pathophysiology and clinical care.
  
  
  METHODS
  Author's perspective on reports of pituitary advances in the published literature.
  
  
  METHODS
  Clinical and translational Endocrinology.
  
  
  RESULTS
  Discovery of the hypothalamic-pituitary axis and mechanisms for pituitary control, have culminated in exquisite understanding of anterior pituitary cell function and dysfunction. Challenges facing the discipline include fundamental understanding of pituitary adenoma pathogenesis leading to more effective treatments of inexorably growing and debilitating hormone secreting pituitary tumors as well as medical management of non-secreting pituitary adenomas. Newly emerging pituitary syndromes include those associated with immune-targeted cancer therapies and head trauma.
  
  
  CONCLUSIONS
  Novel diagnostic techniques including imaging genomic, proteomic, and biochemical analyses will yield further knowledge to enable diagnosis of heretofore cryptic syndromes, as well as sub classifications of pituitary syndromes for personalized treatment approaches. Cost effective personalized approaches to precision therapy must demonstrate value, and will be empowered by multidisciplinary approaches to integrating complex subcellular information to identify therapeutic targets for enabling maximal outcomes. These goals will be challenging to attain given the rarity of pituitary disorders and the difficulty in conducting appropriately powered prospective trials.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California 90048.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Melmed
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000096:biosynthesis; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D010911:Pituitary Neoplasms / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D057285:Precision Medicine
chemical_list: D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone