ESROC : ESROC 40th Anniversary Special Symposium

ESROC -1 TAIWAN ACROMEGALY REGISTRY

FEN-YU TSENG

National Taiwan University Hospital, Taipei, Taiwan

Taiwan Acromegaly Registry was performed with the objectives to describe epidemiological data, treatment outcomes, and quality of life (QOL) of patients with acromegaly in Taiwan. From 2013 to 2015, subjects with acromegaly were recruited through five medical centers. After enrollment, each patient was kept on observation for 1 year.

The analyzed cohort included 272 acromegalic subjects (117 males, 155 females) with a mean age of 51.4 ± 12.9 years. Their mean age at diagnosis was 41.8 ± 12.1 years. The duration between the onset of symptoms/signs and diagnosis was 6.9 ± 8.1 years. Around 70.3% patients harbored a macroadenoma. At enrollment, percentages of patients ever received surgical intervention, radiotherapy, somatostatin analogs, and dopamine agonists were 94.8%, 27.9%, 64%, and 30%, respectively. At the final following-up visit, the remission rate assessed by random GH level ( ≤ 2 μg/ L) was 63.8%. The mean AcroQoL scores for the total 22 items were 64.0 ± 19.7. Remission, defined by normalization of IGF-1, had significant positive association with QOL scores in psychological/ appearance (PSY/APP) dimension. Somatostatin analogues therapy had negative associations with total score and score in psychological (PSY) dimension. Diabetes mellitus had negative associations with score in PSY dimension and psychological/personal relations (PSY/PER) dimensions. Cerebral vascular accident (CVA) had significant negative associations with total score and scores in physical (PHY), PSY, and PSY/PER dimensions. All these associations remained significant even after adjusted with sex and age.

This study described the profiles of acromegaly in Taiwan. It is important to enhance early diagnosis and timely commencement of treatment to prevent serious complications of acromegaly. Our analysis suggested that not only hormone control but also therapeutic regimens and presence of comorbidities might affect QOL of patients with acromegaly in some dimensions.

ESROC -2 THYROID STORM

TAKASHI AKAMIZU

The first department of Medicine, Wakayama Medical University, Japan

Thyroid storm (TS) is a life-threatening disorder with over 10% mortality. In the mid-2000s, its incidence was poorly defined, peer-reviewed diagnostic criteria were not available, and management and treatment did not seem to be verified based upon evidence and latest advances in medicine. We first developed diagnostic criteria based on literature and our patients. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan to obtain and verify information on patients who met diagnostic criteria for TS. Based on these nationwide-survey data, we revised the diagnostic criteria. Furthermre, including the latest information, guidelines for the management and treatment for TS were extensively revised and algorithms were developed. A prospective prognostic study to validate the guidelines is currently ongoing.

References

1. Akamizu T. Thyroid Storm: A Japanese Perspective. Thyroid. 2018 28:32-40 2. Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J. 2016 63:1025-1064. 3. Isozaki O, Satoh T, Wakino S, Suzuki A, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. Treatment and management of thyroid storm: analysis of the nationwide surveys: The taskforce committee of the Japan Thyroid Association and Japan Endocrine Society for the establishment of diagnostic criteria and nationwide surveys for thyroid storm. Clin Endocrinol (Oxf). 2016 84:912-8. 4. Akamizu T, Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Monden T, Kouki T, Otani H, Teramukai S, Uehara R, Nakamura Y, Nagai M, Mori M; Japan Thyroid Association. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid. 2012 22:661-79

ESROC -3 CUSHING’S DISEASE: DIFFICULTY IN DIAGNOSIS, LOCALIZATION & TREATMENT

EUN JIG LEE

Endocrinology, Pituitary Tumor Center, Severance Hospital, Yonsei University, College of Medicine, South Korea

Cushing’s disease (CD) is a rare disease caused by ACTH secreting pituitary tumors, which cause the overproduction of glucocorticoid by the adrenal cortex. Because the overall mortality of patients with uncontrolled hypercortisolism is 4–5 times greater than that in the general population, appropriate treatment of CD is important. Surgical removal of the pituitary adenomas is the treatment of choice in patients with CD; however, until now there have been limitations for diagnosis and localization of the tumor because about 40–50% of corticotroph adenomas are too small to be detected even though by dynamic MR imaging. It has been reported, improved preoperative localization increases the cure rate of transsphenoidal surgery (TSS). Two principal preoperative examinations, inferior petrosal sinus sampling (IPSS) and dynamic MRI imaging are used to identify the tumor. None of the tests used in the diagnosis of CD is 100% reliable, and the best method for localizing pituitary microadenomas remains a challenge. Therefore, particularly in patients with discordant results between IPSS and MRI, the outcome of patients is primarily influenced by the neurosurgeon’s ability. In this session, with illustration of CD patients, we will discuss 1. Diagnosis and differential diagnosis of CD; 2. Usefulness of high-resolution MRI and IPSS for localizing pituitary adenomas; 3. A variety of MR imaging technologies to detect invisible tumor at initial dynamic MRI; 4. A concept, surgical and histological identification (SHI) of tumors while operation by neurosurgeon; and 5. Effectiveness of new steroidogenesis inhibitor.

ESROC -4 ENDOCRINOLOGY IN OSTEOPOROSIS

VIVIEN LIM

Vivien Lim Endocrinology Specialist Centre, Gleneagles Medical Centre, Singapore

Practical aspects of osteoporosis

Osteoporosis is underdiagnosed in Asia and globally. There are pitfalls associated with every aspect of its management from diagnosis to management, not least of which are the secondary endocrine causes that are linked with it. The talk will focus on some pearls of management of various aspects of osteoporosis and will be illustrated by case studies.