PNA Spotlight: Dr. Manish Aghi

Manish AghiThis month the PNA Spotlight focuses on Manish Aghi, M.D., Ph.D., M.A.S., a neurosurgeon at the University of California San Francisco. Dr. Aghi earned a B.S. and M.S. in Biological Sciences from Stanford University, and both an M.D. and an Ph.D. from Harvard University, specializing in neuroscience. He completed a neurosurgical surgery residency and a postdoc at Massachusetts General Hospital. He is currently a professor of neurological surgery at UCSF and his clinical practice specializes in endoscopic skull base surgery.

What inspired you to choose your career path?

I was drawn to pituitary surgery because it represents the perfect overlap between areas of medicine that I am most passionate about. As a medical student at Harvard, I was always fascinated by the regulatory circuits of endocrinology and how their disturbance by pituitary tumors and pituitary disorders so dramatically affects people’s quality of life, disrupting such basic functions as their vision, day-to-day energy, weight, mood, and reproductive function. I was also drawn to neurosurgery, a field in which technology has advanced so rapidly that we are able to provide minimally invasive access to the center of the skull base for safe resection of pituitary tumors with minimal risk and rapid patient recovery.

What is the primary focus of your work/research?

I am a neurosurgeon-scientist at University of California San Francisco (UCSF) specializing in pituitary tumors as part of the California Center for Pituitary Disorders at UCSF. As a neurosurgeon directing the Center for Minimally Invasive Skull Base Surgery at UCSF, I perform nearly 100 endoscopic endonasal procedures for pituitary tumors each year. I am also a scientist running a lab in the UCSF Diller Cancer Research Building, where I have had NIH and industry funding for over a decade to study the mechanisms by which brain tumors like pituitary tumors are able to grow and become resistant to conventional therapies.

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

We are making significant advances in our understanding of the biology of pituitary tumors which will give rise to meaningful benefits for our patients, including new molecular classifications of pituitary tumors that will help clinicians better predict the natural history and therapeutic responsiveness of these tumors and targeted therapies that will offer non-surgical options for some patients.

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

Patients need to know how important multi-disciplinary care is for pituitary disorders. During a single visit to our center, our CCPD patients will typically be seen not only by me, but by an endocrinologist and other pertinent specialists relevant to their condition such as ENT, radiation oncology, or ophthalmology. This ensures that they are receiving the best possible care with decision making made by the consensus opinions of multiple specialists following evidence-based guidelines.

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

I would like to convey to my patients how committed I am to their well-being. When I am not seeing them in clinic, I am constantly reviewing their imaging and hitting refresh on the electronic medical record to get their lab results as soon as they become available, sharing their hopes for durable biochemical remission and preservation of hormonal function. And while I am a neurosurgeon, I am a doctor first and recognize that surgery is a tool that must be reserved for cases that will benefit from surgery, as many incidentally found small tumors have a benign natural history that will be unlikely to harm the patient during their lifetime, making observation through serial imaging the recommended course of action over surgery for these particular patients.

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

I got involved with the PNA more than a decade ago because of how great a resource it is for improving awareness about pituitary disorders and educating both patients and the medical community about pituitary disorders. My involvement with the PNA began with giving talks and leading patient support groups at the sixth bi-annual PNA December in the Desert conference more than a decade ago, and has continued with my giving four patient PNA webinars over the past decade.

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