The pituitary MDT at Royal Stoke had been in place for several years, originally set up by Prof Richard Clayton, Mr Vere Carlin and the Late Mr Jagmohan Singh, providing multi-disciplinary care for the pituitary patients from across Staffordshire and Shropshire. Our centre has been at the forefront of adapting state of the art surgical techniques, having been one of the pioneering centres for using the endoscopic trans-sphenoidal hypophysectomy. We use advanced imaging and digital navigation techniques to enhance the procedure further.
The award-winning MDT currently provides care for pituitary patients from across Staffordshire and Shropshire as well as South Cheshire, parts of North Wales, Derbyshire and the Black Country.
The UHNM MDT has well established links with University Hospitals of Birmingham pituitary MDT and pathology departments. We subscribe to the Pituitary Foundation, thus ensuring that patients are provided with standardised appropriate support throughout their journey from diagnosis to treatment.
Our aims:
We aim to offer the best of care to our patients. Quality, safety, compassion and efficiency are our key goals. Patient satisfaction questionnaires show that the team achieve these consistently.
We aim to continue improving our existing service, with aims to promote clinical research further and maintain our reputation as a centre for excellent training in the region.
Our Services:
Single referral point and triage system:
The referrals from UHNM specialities, GP or from outside the UHNM area are received by neurosurgery, ENT surgery or endocrinology. All referrals are passed on to the pituitary MDT co-ordinator, who with help from the pituitary endocrinologist prepare patient details for discussion at the next available MDT meeting. The patient is contacted to arrange pituitary blood tests, visual field tests and further scans before the case details are discussed at the MDT meeting.
Well established monthly Pituitary MDT Meetings:
All cases referred to the UHNM pituitary MDT are discussed at the monthly multi-disciplinary meeting, usually on the first Monday of every month. The meeting is attended by the pituitary endocrinologists, neurosurgeon, ENT surgeon, neuroradiologists, ophthalmologist, oncologist, MDT coordinator and pituitary nurses in addition to trainees in these specialities. There is an additional monthly meeting, where mostly non-urgent smaller tumours are reviewed.
The MRI scans, visual field results and pituitary bloods are reviewed at the meeting and a joint decision is taken after considering all clinically relevant information in each individual case. Those who need surgery are brought to the joint clinic attended by the endocrinologists and pituitary surgeons.
Pituitary surgery:
Endoscopic Trans-Sphenoidal Hypophysectomy
Trans-cranial Hypophysectomy
Out-patient clinic service:
Monthly MDT clinics – all patients who need surgery, or need complex discussions of all treatment options are seen jointly by surgeon and endocrinologist in this clinic.
Monthly medical pituitary clinic – Dr Jose and Dr Vijay run medical pituitary clinics, where complex patients who need long term surveillance are reviewed as required.
General endocrine clinic support - For those who do not require surgery, follow-up is arranged from the endocrinology out-patient clinics to monitor the tumour and pituitary function.
Radiotherapy:
Those patients with recurrent or refractory pituitary tumours often need radiotherapy to the pituitary gland. The MDT has direct access to clinical oncology services at UHNM to organise assessment. In addition, we refer to Sheffield or Birmingham for stereotactic radiotherapy services MDT in appropriate patients. Proton beam therapy referral is also offered on a case to case basis, and patients are referred to the Proton MDT at Christie’s, Manchester.
Ophthalmology:
Pituitary adenoma and other sellar tumours can affect vision by exerting pressure on the nerve pathways of vision. The MDT is supported by the ophthalmology services at UHNM.
Medical Investigation Unit:
This service is run by our trained endocrine nurses, who also support the pituitary MDT as core members in their role as pituitary nurses. All specialised endocrine blood investigations, pituitary assessments, and clinical reviews are arranged by the nurse team. The endocrinology registrars review all post-pituitary surgery patients and arrange post-operative pituitary tests and MRI scans.
Pituitary Nurse Support:
Dedicated pituitary nurses are available to provide a focal contact point for the pituitary patients. Patients can contact the pituitary nurses directly for advice on their condition and any concerns they have about their health. The nurses are supported by consultants and registrars in endocrinology who can provide urgent input by telephone or in out-patient clinics as required.
