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PNA Spotlight: Dr. Varun R. Kshettry

What inspired you to choose your career path?

Having had the opportunity to observe my father perform heart surgeries when I was growing up, I was originally attracted to the field of medicine because of the technical challenge of mastering surgery. In medical school, I was fascinated with the neurosciences and the impact of neurologic disease on one’s identity. During my training, I fell in love with the complex neuroanatomical relationships of the skull base and the technical challenges associated with the surgical management of skull base disorders. Pituitary tumors can affect the visual, hormonal, and neurologic systems. In addition, many of these tumors are benign and slow growing. These factors can make the decision-making process for patients confusing and it requires a close relationship to appropriately counsel and treat patients and follow them over a long period of time. It also requires close collaboration with ophthalmologists, endocrinologists, and radiation oncologists. I really enjoy these aspects of pituitary care. After formal training in minimally invasive cranial base & pituitary surgery, I began managing a large number of patients with pituitary disorders. Newer surgical techniques have allowed us to provide better surgical care for more difficult tumors that are large and/or invasive. Seeing the benefit we can provide patients with pituitary disorders inspires me to continue to do what I can to advance the field of pituitary care.

What is the primary focus of your work/research?

Much of my research has been on the use of endoscopic endonasal approaches for various pituitary disorders. We have looked at surgical outcomes of endoscopic endonasal approaches for giant pituitary adenomas, functional adenomas, and difficult recurrent tumors as well. As director of our advanced endoscopic & microscopic neurosurgery laboratory, we have studied surgical anatomy and comparative advantages of various open skull base and endoscopic endonasal approaches. Currently, I have been working on clinical trials in the surgical management of pituitary adenomas. I am also collaborating with other scientists to enhance our understanding of the genetic makeup of pituitary adenomas and correlate our findings with the clinical behavior of these tumors. Finally, we are performing comprehensive quality-of-life evaluations to understand what factors contribute most to maximizing the quality of life in our patients with pituitary adenomas.

What do you consider to be the future of your field?

Clearly we see a wide spectrum in how pituitary adenomas behave in terms of growth rate, invasiveness, and recurrence. However, we still have a lot of work to do to better understand the genetic and molecular profile of pituitary adenomas. Further work in this area will allow us to identify tumors that are ‘bad actors,’ which may require more aggressive management strategies or closer monitoring. In addition, this will enable us to come up with potential molecular targets to design additional adjuvant therapies for both non-functional and hormone-secreting tumors.

What should patients know about your field/what deserves more recognition/awareness?

Patients are frequently surprised when I tell them how common pituitary tumors are. I think we should continue to support efforts such as those provided by the PNA to increase awareness of pituitary tumors. For patients with pituitary adenomas, it is important that they understand the existing natural history data of these tumors to avoid unnecessary treatment for asymptomatic, non-functional tumors. Finally, I do believe that patients should get treated at high volume centers with multi-disciplinary teams having significant experience managing these tumors.

What would you like to convey about yourself to your patients?

Being diagnosed with a pituitary disorder produces an overwhelming feeling of uncertainty. My goal is to spend the time with patients to help them understand in non-medical terms their symptoms, imaging studies, and options for treatment including observation. Many pituitary adenomas are discovered incidentally and are not causing any symptoms and can be closely monitored without treatment. Through counseling, patients can feel empowered over their disorder and can make confident treatment decisions. When surgery is indicated, good surgical care not only involves good communication and compassion, but excellent surgical skill and judgment along with use of the latest technological advances.

Why did you get involved with the PNA and what is the extent of your involvement?

I have been impressed with the efforts of the PNA as an organization and have found it to be an excellent resource to my own patients with pituitary disorders.

 

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