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Yale’s Endocrine Neoplasia Program Is Flourishing

January 23, 2023
by Christina Frank

The Yale Multidisciplinary Endocrine Neoplasia Clinic has been treating benign and malignant diseases of the thyroid, parathyroid, adrenal, and pituitary glands since 2013. The program is a collaboration between the Department of Internal Medicine’s Section of Endocrinology & Metabolism and Yale Cancer Center and Smilow Cancer Hospital.

“We now have six endocrinologists, spanning a wide spectrum of expertise, working in conjunction with outstanding endocrine surgeons and neurosurgeons,” said Silvio Inzucchi, MD, professor of medicine (endocrinology) and clinical chief of Section of Endocrinology & Metabolism, a nationally ranked program.

Sachin Majumdar Jr., MD, recently joined the Department of Internal Medicine’s Section of Endocrinology & Metabolism as director of the Endocrine Neoplasia Program. Majumdar was section chief (endocrinology) at Yale New Haven Health’s (YNHHS) Bridgeport Hospital where he was in charge of developing several important care initiatives, including the development of a clinic focused exclusively on thyroid diseases.

“I truly enjoyed my role in clinical education and patient care there, but I was looking to pursue more academic work and also to be able to develop some research programs,” Majumdar said. “We have a very strong teaching component, with fellows rotating in our clinics and also residents from internal medicine. This, in combination with our weekly Endocrine Neoplasia Tumor Board, provides trainees with broad exposure to the multidisciplinary approach to care that is so important these days for successful patient outcomes. That is something that really attracted me. There's a lot of opportunity to grow programs at Yale School of Medicine and Yale New Haven Hospital.”

Because the clinic is growing at such a fast pace, Inzucchi says they intend to recruit more thyroid specialists. Two satellite clinics have already been established—one in 2021 at Long Ridge Medical Center in Stamford by Kavya Menkala, MD, associate professor of medicine (endocrinology), recruited from Wake Forest, where she developed a thyroid nodule / biopsy clinic. The other was in 2022 at Park Avenue Medical Center in Trumbull by Priya Balasubramanian, MD, assistant professor of medicine (endocrinology), and a recent graduate of the Yale Endocrinology & Metabolism fellowship program.

“So now we span from close to the New York border to New Haven, and we have potential opportunities for growth up the shoreline and into middle Connecticut over the next few years,” said Inzucchi. “These new clinics help with local access and also off-load the volume we are experiencing at our main campus, which is now receiving upwards of 10 consultation requests per day.”

Yale Cancer Center and Smilow Cancer Hospital includes a thyroid biopsy clinic—which allows patients to get a consultation as well as a timely biopsy of their thyroid nodules – one of the most common endocrine conditions. Patients also have access to advanced procedures through Yale Diagnostic Radiology, including adrenal vein sampling for the hormonal evaluation of adrenal tumors and inferior petrosal sinus sampling for pituitary tumors. “These are tests that are not done at most other hospitals in the area,” said Majumdar. “So, we are really lucky to have such expertise at Yale New Haven Hospital to conduct such evaluations in our patients.”

“Over the past five years, the use of molecular markers in thyroid cancer has grown significantly. We are now able to determine or predict the biological behavior of certain tumors based on these markers (i.e., more or less aggressive), but more or less amenable to certain therapies,” said Majumdar.

Another standout the Center is its collaborations with neurosurgeons in the management of pituitary tumors, enhanced by a biweekly clinical conference, where the most challenging cases are discussed. One of the unique advantages of pituitary care at Yale lie within the Department of Neurosurgery’s Neurogenetics Program. “Tumor genotyping is a method by which brain tumors, including pituitary tumors, undergo a genetic analysis to see if there are specific mutations that can be identified. This can also help with therapeutic decisions down the road.”

“We offer something that no other center in Connecticut can – high volume, collaborative care, drawing on the expertise of multiple departments,” said Inzucchi. “The ability to work in a multidisciplinary team means the more difficult cases can be managed across specialties to arrive at the most appropriate state-of-the-art treatment regimen for each individual patient.”

Yale’s Section of Endocrinology & Metabolism works to improve the health of individuals with endocrine and metabolic diseases by advancing scientific knowledge; applying new information to patient care; and training the next generation of physicians and scientists to become leaders in the field. To learn more about their work, visit Endocrinology & Metabolism.

Submitted by Julie Parry on January 24, 2023