Helpful Doctors: Dr. Sandeep Kunwar

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Dr. Sandeep Kunwar is an eminent neurosurgeon who serves on the PNA’s Board of Directors. He is surgical director of the California Center for Pituitary Disorders and a professor of neurosurgery at UCSF. He is also surgical director at the Taylor Bell Neuroscience Institute in the Washington Hospital Healthcare System in Fremont, CA. He opened his private practice there in 2006. He received a Bachelor of Arts degree from UC Berkeley in 1988. From 1991-2 he trained as a Howard Hughes Medical Institute Research Scholar at the National Cancer Institute, working in the laboratory of molecular biology. He went to graduate from UCSF medical school in 1993, did his residency there in neurological surgery in 1998, and joined the faculty upon completion in 1999. From 1997-98 he served as a Research Fellow in the Brain Tumor Research Center at UCSF. He was selected by renowned pituitary surgeon Dr. Charles Wilson to take over his practice upon retirement.

Dr. Kunwar specializes in gamma knife radiosurgery for metastatic and primary brain tumors, and uses the endonasal approach for pituitary tumors. His research works to improve surgical therapy for brain tumors, particularly glioblastomas. He has pioneered a minimally invasive surgical technique for skull-based tumors and has successfully applied that skill to transcranial and spine patients as well.
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He was kind enough to answer questions from the PNA. His responses follow.

• What inspired you to choose your career path?

My interest in the brain started after a personal experience. I developed amnesia after a fall when living in Chicago while in elementary school. This lead to my fascination in how memory was processed, how chemical reactions can tell us that 2+2=4. Later in life, inspired by my father who loved working with his hands, I realized that I had an interest in neurosurgery. After attending medical school and residency at the University of California, San Francisco, my research and clinical interest focused on brain tumors. I was fortunate to work closely with Dr. Charlie Wilson who inspired the pursuit of perfection and always doing what is best for the patient. It was under Dr. Wilson’s tutelage that I understood the power of hormonal health on an individual’s quality of life, the elegance of transsphenoidal surgery for pituitary pathology, and the impact a single surgeon can have. He instilled in me the concept that we must strive to do better. When he retired two decades ago, I committed myself to improving the treatment of pituitary tumors, honing not only my surgical skills (we started performing the endonasal transsphenoidal approach in 2001, eliminating the need for nasal packing and shortening the hospital stay to one day for most patients) but my understanding of hormonal health. Although I work with the best neuro-endocrinologists at UCSF, I tried to learn as much as they know to best help my patients.

• What is the primary focus of your work/research?

My main work focus has been the treatment of pituitary tumors, in improving the outcomes and decreasing the complications. For example, we have worked on techniques to maintain or improve pituitary hormonal function. The goal of preserving the thinned out, damaged gland that remains is as important as curing/treating a tumor. This includes using multimodal therapy if needed to optimize a patient ‘s normal hormonal health. In the end, these are benign tumors and the results of treatment should never be worse than the disease. We need to minimize/eliminate the risks of damaging the gland (including diabetes insipidus), meningitis, and CSF leaks; and maximize our chance of curing the tumor. Finally, it is imperative to pass these skill sets to the next generation of surgeons.

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

In the short term, the risks of surgery will decrease and the options for multimodal therapy will increase. For example, we will see better drugs to control hormonal hypersecretion, more focused and readily available ways to give radiation therapy (radiosurgery), and more uniform outcomes among different centers/surgeons. In the long run, I hope we can regenerate normal pituitary function in those patients that have lost their function because of their tumor or treatment.

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

The PNA has done an excellent job in educating patients about the importance of experience and multidisciplinary groups in the management of pituitary pathology. The greatest impact in outcome is technique and experience. Unfortunately, the tools used to perform surgery have become a focus for some. This has become a marketing tool which can confuse patients and detract from the main issues which are the surgeon’s experience/outcomes and the goals of treatment.

What deserves continued recognition is early diagnosis. The key to improving outcomes for all patients in the future is early diagnosis. It was this goal that made PNA so appealing to me. With early diagnosis, cure is easier to achieve, preservation of the normal gland function is more readily possible and the overall impact of hormone abnormalities can be limited.

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

There are many very talented and accomplished neurosurgeons, perhaps fewer spectacular pituitary-specific surgeons. It is important to choose a surgeon with experience and one who understands pituitary pathology, one who can explain his or her goals, outcomes and complications and most importantly, one you feel comfortable with. I’ve had the great honor to operate on over 2,500 pituitary patients. For each, it remains the best part of my job to take time to educate them about their disease, the cause of their symptoms, the anatomy of their tumor and our goals in treating their pathology. Maximizing cure must always be balanced with minimizing risk, and having a great team to help support the process are the key to success. I would thank all the patients who have put their faith in me – it is an honor and a privilege to be part of their care.

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

Education remains the most powerful tool in improving health, and that has been on the forefront of the PNA. I got involved with the PNA because of my respect and admiration for Robert Knutzen back in 2004. I served on the board early on and have contributed to the educational information available. I fully support the PNA’s focus on patient education and in improving earlier diagnosis.

From https://pituitary.org/highlights-enewsletter-child/pna-spotlight-dr-sandeep-kunwar-2-2-2-2-2-2-2-2-2-2/

Adrenal Insufficiency Common After Adrenalectomy for Mild Autonomous Cortisol Secretion

MaryO Cushing's Awareness Challenge

Key takeaways:

  • Of adults who underwent an adrenalectomy for mild autonomous cortisol secretion, 54.4% developed adrenal insufficiency.
  • More than half of those with adrenal insufficiency recovered within 6 months.

More than half of adults who underwent a unilateral adrenalectomy to treat mild autonomous cortisol secretion developed adrenal insufficiency, according to data published in The Journal of Clinical Endocrinology & Metabolism.

In a retrospective study of patients who underwent an adrenalectomy at five centers in the U.S., adrenal insufficiency was diagnosed in 54.4% of the study group after the procedure. Adrenal insufficiency was more likely to be diagnosed among younger adults, and 73% of diagnosed adults recovered in less than 1 year with glucocorticoid treatment.

More than half of adults who underwent an adrenalectomy for mild autonomous cortisol secretion developed adrenal insufficiency. Data were derived from Hamidi O, et al. J Clin Endocrinol Metab. 2025;doi:10.1210/clinem/dgaf515.

“The findings support the use of both postoperative cortisol testing — basal cortisol or cosyntropin stimulation test — to accurately diagnose adrenal insufficiency and guide glucocorticoid therapy,” Irina Bancos, MD, MSc, professor of medicine and adrenal lab principal investigator in the division of endocrinology, metabolism and nutrition at Mayo Clinic, and Oksana Hamidi, DO, MSCS, associate professor in the division of endocrinology at UT Southwestern Medical Center, told Healio. “This testing approach can help avoid unnecessary glucocorticoid exposure while ensuring patient safety.”

Irina Bancos

Researchers collected data from 281 adults aged 18 years or older diagnosed with mild autonomous cortisol secretion between January 2013 and August 2024 who underwent a unilateral adrenalectomy (80% women; median age, 57 years). Patients were deemed to have adrenal insufficiency if they received a clinical diagnosis based on symptoms and results from basal cortisol and cosyntropin stimulation testing, if they had a basal cortisol level of less than 10 µg/dL and a stimulated cortisol level on a cosyntropin stimulation test of less than 18 µg/dL. If there were discordant basal cortisol level and cosyntropin stimulation test results, the decision to initiate glucocorticoid therapy was made by the treating physician, taking into account the clinical context and individual patient factors.

Of the study group, 54.4% were diagnosed with postoperative adrenal insufficiency and treated with glucocorticoids. In multivariable analysis, every 10 years of older age reduced odds for an adrenal insufficiency diagnosis by 33% (OR = 0.67; 95% CI, 0.53-0.84).

Bancos and Hamidi said they were surprised at how strong the association was between age and adrenal insufficiency.

Oksana Hamidi

“The strong inverse relationship between age and risk of adrenal insufficiency observed in our study could suggest that younger patients may derive greater benefit from adrenalectomy for mild autonomous cortisol secretion,” Bancos and Hamidi said. “Younger patients also had higher dexamethasone suppression test cortisol and lower adrenocorticotropic hormone, reflective of more severe mild autonomous cortisol secretion.”

Of the participants, 60.1% had a low basal cortisol level of less than 10 µg/dL, and 57.6% had a reduced simulated cortisol level of less than 18 µg/dL. Basal and stimulated cortisol were concordant on adrenal insufficiency diagnoses for 78% of patients. Adults who had bilateral nodules were more likely to have discordant results between the cortisol tests than adults with a unilateral nodule (32% vs. 19%; P < .001).

Of adults diagnosed with adrenal insufficiency, 70.6% recovered during a median follow-up of 15.4 months. The proportion of diagnosed adults who recovered was 41% at 3 months, 60% at 6 months, 73% at 1 year and 84% at 18 months. Median recovery time was 3 months for adults with biochemically mild adrenal insufficiency, 4.7 months for those with moderate insufficiency and 14.5 months for adults with severe adrenal insufficiency (P = .02). Recovery times were similar when adrenal insufficiency severity was assessed through clinical severity score.

Bancos and Hamidi said the study findings emphasize the importance of conducting frequent postoperative testing for adrenal insufficiency, noting that regular testing can help avoid prolonged glucocorticoid exposure for patients.

“Early recovery is common,” Bancos and Hamidi said. “Delayed testing may lead to unnecessary glucocorticoid exposure and delay recovery.”

Additionally, Bancos and Hamidi said dexamethasone and other steroids should not be given to patients during an adrenalectomy or while administering anesthesia, as they may confound cortisol testing. They said endocrinologists should work with the anesthesia and surgical teams to optimize timing of postoperative cortisol testing.

For more information:

Irina Bancos, MD, MSc, can be reached at bancos.irina@mayo.edu.

Oksana Hamidi, DO, MSCS, can be reached at oksana.hamidi@utsouthwestern.edu.

From https://www.healio.com/news/endocrinology/20251001/adrenal-insufficiency-common-after-unilateral-adrenalectomy?utm_source=selligent&utm_medium=email&utm_campaign=20251004ENDO&utm_content=20251004ENDO

Basics: The Role of Endocrinology in Managing Polycystic Ovary Syndrome and Diabetes

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Introduction to Endocrinology

Endocrinology is a medical specialty that focuses on the diagnosis and treatment of diseases related to hormones. Endocrinologists are experts in managing and treating diseases related to the endocrine system, which includes the thyroid, pituitary, adrenal glands, and pancreas. Endocrinologists are trained to diagnose and treat conditions such as diabetes, thyroid disorders, pituitary disorders, and other conditions related to hormones. Endocrinologists also specialize in reproductive health and fertility issues, including PCOS.

Endocrinology is a complex field that requires a deep understanding of the endocrine system and its role in regulating the body’s hormones. Endocrinologists must be able to interpret laboratory tests and understand the underlying causes of endocrine disorders. They must also be able to develop individualized treatment plans to address the specific needs of each patient.

Diagnosing PCOS and Diabetes

Endocrinologists are experts in diagnosing and managing PCOS and diabetes. PCOS is a hormonal disorder that affects the ovaries, and it is characterized by irregular menstrual cycles, excess facial and body hair, and infertility. To diagnose PCOS, an endocrinologist will perform a physical exam and order laboratory tests to measure hormone levels. The endocrinologist will also ask the patient about her symptoms and family history to determine if PCOS is the cause.

Diabetes is a chronic condition that affects the body’s ability to process sugar. To diagnose diabetes, an endocrinologist will perform a physical exam and order laboratory tests to measure blood sugar levels. The endocrinologist may also order imaging tests to check for signs of diabetes-related complications.

Treating PCOS and Diabetes

Once the endocrinologist has diagnosed PCOS or diabetes, they will develop an individualized treatment plan to address the patient’s specific needs. For PCOS, the endocrinologist may recommend lifestyle changes such as weight loss, exercise, and dietary changes to help manage symptoms. The endocrinologist may also prescribe medications to regulate hormone levels and improve fertility.

For diabetes, the endocrinologist may recommend lifestyle changes such as weight loss, exercise, and dietary changes to help manage blood sugar levels. The endocrinologist may also prescribe medications to help regulate blood sugar levels. In addition, the endocrinologist may recommend regular check-ups to monitor the patient’s progress and to adjust the treatment plan if needed.

Conclusion

Endocrinology plays an important role in managing PCOS and diabetes. Endocrinologists are experts in diagnosing and treating these conditions, and they are trained to develop individualized treatment plans that address the specific needs of each patient. By working with an endocrinologist, patients can get the help they need to manage their PCOS or diabetes and achieve their health goals.

Endocrinology is a complex field that requires a deep understanding of the endocrine system and its role in regulating the body’s hormones. An endocrinologist can help patients with PCOS and diabetes manage their conditions and achieve their health goals. By working with an endocrinologist, patients can get the help they need to manage their PCOS or diabetes and achieve their health goals.

From https://www.diabetesincontrol.com/the-role-of-endocrinology-in-managing-polycystic-ovary-syndrome-and-diabetes/

Helpful Doctor: Dr. Rudruidee Karnchanasorn

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Dr. Rudruidee Karnchanasorn is featured in the video and seems very knowledgeable about Cushing’s.

This interview offers a powerful first-hand account of what it’s really like to live with Cushing’s disease—from the daily struggles and the journey to diagnosis, to the experience of undergoing transsphenoidal pituitary surgery.

Dr. Rudruidee Karnchanasorn is certified by the American Board of Internal Medicine. She completed a fellowship at the City of Hope Medical Center. She earned her medical degree from Mahidol University Siriraj Hospital and completed her residency at Michigan State University.

Education

City of Hope National Medical Center

Fellowship, Endocrinology and Metabolism, 2011

Michigan State University

Residency, Internal Medicine, 2009

Michigan State University

Internship, Internal Medicine, 2007

Somdetphraput Thalertla Regional Hospital

Internship, 2005

Mahidol University School of Medicine Siriraj Hospital

Medical School, Doctor of Medicine, 2004

Board Certifications

Endocrinology Diabetes and Metabolism

American Board of Internal Medicine, 2011

⁉️ Myth: “Vitamins and Natural Remedies can cure/heal Cushing’s”

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More from Dr. Karen Thames:

Myth: “Vitamins and Natural Remedies can cure/heal Cushing’s”

myth-busted

Fact: Do you know how many people have told me that if I just “juice”, I will be cured from Cushing’s or Adrenal Insufficiency?! I appreciate the sentiment, but the sad reality is that no amount of juicing and no vitamin will cure Cushing’s. Some Cushing’s patients do take vitamins, some do eat raw food or paleo diets, and some even juice. However, this is just a lifestyle choice and not an attempt to cure Cushing’s. I must admit that when you have such a dreadful disease, you do sometimes take desperate measures to heal yourself. Perhaps, doing acupuncture or some other form of natural healing technique seems attractive at times. Take it from a person who has had acupuncture, seen many natural doctors, juiced, took vitamins, ate a raw food diet, and yes, I EVEN did a series of colonics! If you have ever had colonics, you know that it brings new meaning to the phrase, “no pain, no gain!”

Seriously, this is all before I knew I had Cushing’s. I watched as every person who administered the different kinds of treatment scratched their heads as I continued to gain weight, eventually at a rate of 5 pounds per week! They couldn’t believe that I was actually still gaining weight. Their natural and not surprising response, of course, was to project blame onto me. “Karen, there is NO way you are following protocol! You MUST be lying on your food log!” What we all didn’t realize is that I was suffering from a life-threatening illness called Cushing’s Disease that caused morbid obesity in me and that none of those “remedies” would EVER work!

Now, I have already been in Twitter wars over this topic. Someone tried to tell me that a raw food diet will “cure Cushing’s” and then she told me that I am “ignorant and in denial”! She proceeded to tell me that her daughter, though she had surgery to treat Cushing’s, was REALLY cured because of changing her diet. She also told me that the daughter, who had her Adrenal Glands removed, didn’t need steroids. Listen folks, this is VERY dangerous! I have no adrenal glands and I NEED steroids! Cortisol is life sustaining and you will die without it! I fully expect that someone will argue this point until the cows come home. It doesn’t matter. It won’t change the facts. Cushing’s is caused by excess cortisol in the body. The ONLY treatment is to target the source of the excess cortisol (i.e.brain tumor, adrenal tumor, ectopic tumor, or prolonged steroid use for another disease). Targeting the source is the first line of treatment. Cushing’s Syndrome/Disease will lead to death if not treated properly! #BattlegroundDiagnosis

Disclaimer: I am not a medical doctor. Please seek the advice of a medical professional if you have questions or need further assistance.

If you want to follow our documentary, please go to http://www.Facebook.com/Hug.A.Cushie

 

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Basics: Diagnostic Procedures in Suspected Adrenocortical Carcinoma

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Patients with suspected adrenocortical carcinoma (ACC) may also undergo additional tests to identify excess sex steroids and steroid precursors, mineralocorticoids and glucocorticoids.

Table 2 provides a summary of the tests recommended by the European Society of Endocrinology in collaboration with the European Network for the Study of Adrenal Tumors in patients with suspected ACC.10

Table 2. Diagnostic work-up in patients with suspected or proven adrenocortical carcinoma. Reproduced from Fassnacht et al., 2018,10 with permission under a Creative Commons Attribution 4.0 International License.
ACTH: adrenocorticotropic hormone; DHEA-S: dehydroepiandrosterone sulphate; CT: computed tomography; FDG-PET: 18F-fluorodeoxyglucose positron emission tomography; MRI: magnetic resonance imaging.
  • Click image to enlarge

Basics: Pseudo-Cushing’s syndrome

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Pseudo-Cushing’s syndrome is when symptoms are similar to those of Cushing’s syndrome, but further tests show that the syndrome is not present.

Common causes include consuming too much alcohol, obesity, persistently high blood glucose levels, pregnancy, and depression.

 

Basics: What Causes Abnormal Cortisol Levels?

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Cortisol isn’t bad; you need it to help regulate your responses to life. Regulation involves a very complex interplay of feedback loops between the hypothalamus, pituitary gland, and adrenal glands, says Dr. Singh.

“In general, cortisol levels tend to peak in the late morning and gradually decline throughout the day,” he explains. “When a stressful event occurs, the increased cortisol will work alongside our ‘fight or flight’ mechanisms to either upregulate or downregulate bodily functions. [Affected systems include] the central nervous system, cardiovascular system, gastrointestinal system, or immune system.”

In addition to normal processes that trigger or suppress cortisol release, levels can also be affected by different medical conditions, Dr. Singh says. For example, if someone has abnormally high levels of cortisol, this is called Cushing’s syndrome, which is typically caused by a tumor affecting any of the glands that take part in the process of cortisol production.

When people suffer from abnormally low levels of cortisol, it’s called Addison’s disease. It generally occurs due to adrenal gland dysfunction, but could also be the result of abnormal functioning of any of the other glands in the cortisol production process.

Finally, if you use corticosteroid medications such as prednisone or dexamethasone, prolonged use will result in excessive cortisol production, Dr. Singh says.

“If the medication is not adequately tapered down when discontinued, the body’s ability to create cortisol can become permanently impaired,” he says.

From https://www.yahoo.com/lifestyle/manage-pesky-stress-hormone-cortisol-184900397.html

 

🎬 Video: Taylor Davis Spreads Awareness about Cushing’s Disease

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FLORENCE, SC (WBTW) – 21-year-old Taylor Davis, spent nearly three years battling a mysterious illness called Cushing’s Disease.

“I could barely walk to class anymore. I was in pain. I gained like 70 pounds, despite extreme dieting and exercising,” said Davis.

When Davis enrolled into her spring semester classes at USC, she started experiencing several symptoms.

“I noticed my grades started to take a fall and I was like ok something is seriously wrong here because I’ve never had trouble in school and I could stay up studying all night long and not remember anything the next day,” said Davis.

Davis went from doctor to doctor, but no one could figure out what was wrong with her.

“I thought I was going crazy. Every doctor would say keep trying to diet and exercise and we’ll get you on some medication for your depression and your anxiety,” said Davis.

After dropping out of USC and spending time in the emergency room, a Cushing’s Disease Facebook group led her to a research doctor in California.

“Around October is when the doctor officially diagnosed me and within a month I had my brain surgery scheduled,” said Davis.

Fast forward a couple months later, Davis is thankful to share her experiences on social media and help others going through the same disease.

“I post about it all the time and by using the hashtags for Cushing’s disease, I probably get three to four messages a day from people all over the world. I’ve had people message me in Spanish and I have to use google translate to try and help them,” said Davis.

From https://www.wbtw.com/news/a-woman-in-the-pee-dee-spreads-awareness-on-mysterious-disease/

💉 Helpful Doctors: North Carolina

MaryO Five Star, Helpful Doctors, North Carolina , , , ,

 

Sherry A added her helpful doctor, Matthew Gorris.

How would you rate your Helpful Doctor? 5/5
Your Doctor’s Name Dr. Matthew Gorris
Your Doctor’s Address Medical Center Boulevard
City: Winston Salem
State / Province: NC
Postal / Zip Code: 27157
Your Doctor’s Phone Number (336) 713-7251
What are your Doctor’s Specialties? Endocrinologist
Hospital Affiliation Wake Forest Baptist Medical Center
Comments Excellent Doctor, Takes his time, actively listens to his patients concerns and addresses questions in an easy to understand manner.

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