PL Plenary Lecture (1-4

PL-1

PROGRESSION MECHANISM AND TREATMENT OF DIABETIC NEPHROPATHY UPDATE

HIROFUMI MAKINO, M.D., PH.D.

Director, Okayama University Hospital

Diabetic nephropathy is one of the most serious complications of diabetes. End-stage renal disease (ESRD) due to diabetes is the leading cause and the incidence is very high especially among Asian countries headed the list of percentage of incident patients with ESRD, compared to Western countries. Interestingly, Asian countries with high salt intake revealed high incidence of ESRD, meanwhile, Western countries with low salt intake demonstrated low incidence of ESRD.

Diabetic nephropathy is characterized by accumulation of extracellular matrix in glomeruli, called exudative, diffuse and nodular lesions. They are finally followed by glomerulosclerosis and transplantation to survive. nephropathy and the identification of key molecules would facilitate to the development of new of glucagon-like peptide-1 (GLP-1) receptor agonist and dipeptidyl peptidase-4 (DPP4) inhibitors, which ameliorated the progression of diabetic nephropathy in rodent models. We also investigated the nephropathy using various animal models and reported SGLT2 inhibitors primarily ameliorates oxidative stress and inflammation in proximal tubular cells. New therapies such as incretin-related beyond blood glucose control.

PL-2

UNDERSTANDING BIOLOGY OF DIABETES AND RELATED METABOLIC DISORDERS

L-M CHUANG

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Diabetes and related metabolic disorders are the most challenging health problems in this century. During the past decades, it is noted an increasing trend of type 2 diabetes, esp. in young population, in the Asian countries including Taiwan. The causes of these metabolic disturbances are multifactorial basis involving both genetic and environmental factors with a seemingly similar underlying defect in insulin sensitivity. To tackle these health problems, we took a wide variety of approaches in the past, mainly translational approach to study the issues of interest, testing the central defect of the disorders,

In this talk, I will describe our experience of the approaches to study both clinical and basic aspects of the complex diseases such as diabetes and the related metabolic disorders. Based upon the etiology of those complex diseases and look forward to developing novel therapeutic opportunities. We the nature of these ever-expanding disorders that affect our population now and in the coming years.

PL-3

ENDOCRINE HYPERTENSION

WILLIAM F. YOUNG, JR., MD, MSC

Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA

Hypertension may be the initial clinical presentation for at least 15 endocrine disorders. An accurate diagnosis of endocrine hypertension provides clinicians with the opportunity to render a presentation I will answer questions about and provide clinical tips on the diagnosis and treatment of primary aldosteronism and pheochromocytoma.

Primary aldosteronism (PA). When can the clinician ignore the clinical practice guideline tomography in distinguishing between unilateral aldosterone-producing adenoma and bilateral

Pheochromocytoma and Paraganglioma (PPGL). How has the clinical presentation of PPGL should be use suppression testing with clonidine or provocative testing with histamine or glucagon to

PL-4

GRAVES’ ORBITOPATHY: AN IMPORTANT ISSUE FOR OPHTHALMOLOGIST AND ENDOCRINOLOGIST

T-C CHANG

Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan, R.O.C.

Graves' thyroid eye disease which was referred to as Graves' ophthalmopathy, is primarily a disease of the orbit and therefore now called as Graves' orbitopathy. It is an important issue for both ophthalmologist and endocrinologist. Although easily diagnosed by an experienced endocrinologist, it may be treated as conjunctivitis by many doctors. This may result in delaying diagnosis and let the patient progress to irreversible changes or even visual loss due to the compression of the optic nerve. tomography without contrast medium. In endemic area of HBsAg carrier, check-up of HBsAg before treatment is necessary. If HBsAg is positive, using antiviral agent before pulse therapy can avoid the flare-up of hepatitis B. Pulse therapy with methylprednisolone 250-500 mg depending on the body a consecutive of 3 days every 3 to 4 weeks, totally 6 months, is the effective and cheap way to obtain the therapeutic effect without Cushingoid effect. However, because of excitement may occur after high dose of methylprednisolone infused, patient may have insomnia. Therefore, short-term sedatives before sleep during the days of pulse therapy may be needed. In addition to avoid the smoking, control of thyroid function and wearing goggle during the night are needed. If patient still has diplopia or significant exophthalmos, or impairment of visual acuity after pulse therapy, well-experienced ophthalmologist can further do staged surgery to have better results.