Agenda
Contents Floor Plan of Conference Rooms ....................................................................................... 2 Daily Program Schedule ...................................................................................................... 5 ESROC-KES 會議連結說明 ................................................................................................. 7 Opening Remarks ................................................................................................................. 8 Board of Directors ............................................................................................................... 10 Sponsors .............................................................................................................................. 11 Moderator & Speaker.......................................................................................................... 12 Agenda ................................................................................................................................. 15 Abstract PL：Plenary Lecture (1-4) ................................................................................................. 36 MTP：Meet the Professor (1-2) ......................................................................................... 43 DAROC-TADE：DAROC-TADE Joint Symposium....................................................... 45 SE：Symposium-Endocrine (1-9)...................................................................................... 49 SD：Symposium-Diabetes (1-9) ........................................................................................ 84 ESROC-KES： ESROC-KES Joint Symposium .......................................................... 120 AR：2021 Outstanding Research Award.......................................................................... 126 AP：2021 Outstanding Paper Award ............................................................................. 128 OE：Oral Presentation-Endocrine (1-6) .......................................................................... 135 OD：Oral Presentation-Diabetes (1-6) ............................................................................ 145 PE：Poster Presentation-Endocrine (1-33) ...................................................................... 155 PD：Poster Presentation- Diabetes (1-14) .................................................................... 204 BP：廠商論文壁報展示 (1-3)....................................................................................... 225 1
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
Floor Plan of Conference Rooms
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
Daily Program Schedule
社團法人中華民國內分泌暨糖尿病學會 第 15 屆第 1 次會員大會暨學術研討會 日期：民國 111 年 3 月 19-20 日／地點：臺大醫院國際會議中心
節目表 March 19, 2022 (Saturday) Room 101
Room 301
Room 401
Room 402AB
Room 402CD
Room 202
Room 203
600 人
220 人
220 人
200 人
200 人
80 人
80 人
ESROC-KES ESROC-KES Joint Symposium (10:00-12:00)
Workshop Thyroid RFA Workshop (9:00-11:30)
DAROCTADE DAROC-TADE Joint Symposium
08:00-12:00
Hand on 主持人：曾芬郁 指導老師：吳明勳 Jae Hoon Chung 鄭凱倫 李宇璇 演講者： Tae Hyuk Kim 林樹福 Min-Hee Kim 林家宏
主持人：王治元 陳榮福 歐弘毅 杜思德 黃建寧 許惠恒 演講者：沈峰志 洪晧彰 杜業豐 張 媚
12:00-13:00
LS1~2, LS4~9 ( 午餐會議詳細請參考節目內容 )
13:10-13:20
Opening (Room 101) 主持人：曾芬郁、黃建寧
13:20-14:05
PL-1 Plenary Lecture 1 (Endocrine) (Room 101) 主持人：曾芬郁 演講者：王佩文
14:05-14:50
PL-2 Plenary Lecture 2 (DM) (Room 101) 主持人：黃建寧 演講者：John Wilding Break//Poster Presentation (Poster Stand 3F Walkway) 海報展示評分 PE 王舒儀、周振凱、林志弘 PD 林嘉鴻、王俊興、李建興
15:00-15:20
晚宴場佈
15:20-17:00
17:00-18:00 18:00-21:00
SD-1
SE-1
SE-2
SD-2
SE-3
SD3
DM and Brain
Thyroid Eye Disease
Endocrinology and Aging
DM and Kidney （Goal 50：良程 控糖保腎力計畫 回顧與展望）
Pituitary
DM and Hepatitis & Young Investigator Research Report
主持人：鄭建興 林慶齡 胡朝榮 演講者：湯頌君 鍾芷萍 宋碧姍
主持人：陳思達 施翔蓉 演講者：周宣彣 魏以宣 陳冠樺
主持人：王治元 歐弘毅 演講者：許智堯 鄭為仁 陳亮恭
主持人：黃建寧 洪乙仁 裴 馰 王治元 演講者：張恬君 王俊興 林昆德 汪宜靜
主持人：陳涵栩 張慶忠 演講者：林冠宇 毛羿傑 王俊興
主持人：莊立民 蘇景傑 陳清助 演講者： Ken C.Chiu 張以承 鄭凱比
MTP-D
MTP-E
OE
OD
主持人：蔡世澤 演講者：李弘元
主持人：林宏達 演講者：顏若芳
主持人：李亭儀 簡銘男 劉鳳炫
主持人：蘇景傑 楊宜瑱 林昆德
Welcome Dinner (Conference Room 101)
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
March 20, 2022 (Sunday) Room 101
Room 301
Room 401
Room 402AB
Room 402CD
Room 205
600 人
220 人
220 人
200 人
200 人
80 人
SE-4
SE-5
SD-4
SD-5
SE-6
SD-6
DM and Cardiovascular Disease
Lipid Guideline for Primary and Secondary Prevention
主持人：朱志勳 林時逸 楊偉勛 演講者：呂信邦 田凱仁 吳卓鍇
主持人：戴東原 葉振聲 曾慶孝 演講者：楊偉勛 黃柏勳 吳造中
COVID-19 & Hyperparathyroidism Endocrine Diseases (case sharing)
08:00-09:40
主持人：曾芬郁 林宏達 演講者：林思涵 羅學榮 溫振宇
主持人：蔡克嵩 李亭儀 演講者：李晏榮 杜業豐 邱偉益
Pheochromocytoma Beta Cell Centric and Paraganglioma Approach of Diabetes Treatment 主持人：張慶忠 劉鳳炫 演講者：陳沛隆 林怡瑄 林亮羽
主持人：莊峻鍠 何橈通 莊立民 演講者：張恬君 陳天華 蔡佩君 楊文欽
09:40-10:00
Break (Poster Stand – 3 F Walkway)
10:00-10:45
PL-3 Plenary Lecture 3 (Endocrine) (Room 101) 主持人：蔡克嵩 演講者：闕士傑
10:45-12:20
General Assembly 會員大會 (Room 101)
主持人：曾芬郁、黃建寧
12:20-12:30
Group Picture 會員大合照 (1st Floor Square)
12:30-13:30
LS10~LS17( 午餐會議詳細請參考節目內容 ) PL-4 Plenary Lecture 4 (DM) (Room 101)
13:35-14:20 14:20-14:40
14:40-16:20
16:20-16:30
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主持人：許惠恒 演講者：歐弘毅
Break (Poster Presentation -3 Floor Walkway) SD-7
SD-8
SE-7
SE-8
SD-9
SE-9
Type 1 DM Guideline
DM and Bone
Thyroid Cancer
Neuroendocrine Tumors
DM and Liver
Rare Endocrine Diseases
主持人：胡啟民 李燕晉 羅福松 黃建寧 演講者：沈宜靜 林嘉鴻 童怡靖 張恬君
主持人：黃兆山 蔡克嵩 杜思德 陳榮福 演講者：王超然 郭仁富 蔡嘉仁
主持人：王佩文 林怡君 演講者：張雁翔 吳明勳 官鋒澤
主持人：歐弘毅 簡銘男 演講者：李健逢 鄭媚方 蔡慧珍
主持人：林漢傑 李弘元 何橈通 高嘉宏 演講者：楊宏志 黃志富 李癸汌
主持人：陳涵栩 施翔蓉 演講者：陳亭竹 曾耀賢 王子源 陳維常
Closing
ESROC-KES 會議連結說明
ESROC-KES 會議連結說明 ＊本次年會外賓演講之場次僅 ESROC-KES joint symposium 採 hybrid 方式進行，其餘 場次採預錄影片撥放，歡迎會員踴躍參與聆聽。 ESROC-KES joint symposium 線上會議登入 連結和操作步驟 (3/19 當天開放直播觀看 ) 直播連結 : https://zoom.us/webinar/register/WN_ QRcpGLzqQT6_GcsqCUY2Yw 掃描 Qrcode 登入：
操作步驟 : 1. 點選連結或掃描 Qrcode，於 註冊頁面填入 姓名、Email 和服務單位。 2. 註冊完成後，5-10 秒內，註 冊 的 信 箱 將 收到登入信件，點選信件內連結即可觀看 課程，會員提前註冊或當天註冊皆可立即 收信觀看。 ( 課程僅 3/19 當天開放 )
注意事項： 1. 課程當日若使用 Wifi 或手機網路上課因網路環境、設備差異、使用人數等眾多因素皆會 影響連線品質，建議使用有線網路連線品質較穩定。 2. 本次年會學術課程皆以現場報到參與才核予繼續教育學分，僅線上觀看沒有學分。
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
理事長致詞 中華民國內分泌學會暨糖尿病學會 111 年年會由內分泌學會主辦，今年第 14 屆 理監事任期屆滿，除了豐富的學術研討會外，我們也將選舉兩會的第 15 屆理監事。 內分泌學會邀請王佩文教授及闕士傑教授擔任 plenary lecture，分別以「甲狀腺癌」 及「原發性高醛固酮症」為演講主題；我們也邀請顏若芳教授以「內分泌疾病的核子 醫學診斷與治療」做專家特別演講；我們安排了甲狀腺射頻消融實作課程、與韓國 內分泌學會的 joint symposium，以及 Thyroid eye diseases、Endocrinology and aging、 Pituitary、COVID-19 & Endocrine Diseases (case sharing)、Hyperparathyroidism、 Pheochromocytoma and Paraganglioma (PPGL) 、Thyroid Cancer、Neuroendocrine tumors、 Rare Endocrine Diseases 等 9 個 symposium，加上糖尿病學會安排的學術節目、 會員投稿的 oral presentation 、poster presentation 以及藥界同仁安排的 lunch symposium 等，節目內容多元精彩，是很豐盛的學術饗宴，相信所有的會員都能夠在這場學術大 會中收穫滿滿。內分泌學會於年會期間同時出版「生長與發育」、「臨床內分泌與新 陳代謝名詞」兩本專刊，可以提供會員臨床參考。 謹此感謝所有主持人及演講者、糖尿病學會黃建寧理事長、內分泌及糖尿病學會 兩會的秘書長、副秘書長、秘書、所有的贊助者，更謝謝所有會員的參予與支持。 今年改選理監事後，我個人將完成內分泌學會理事長的任務。感謝大家的支持與 協助，在兩屆任期內，我們完成購置學會辦公室、學會網站更新、學會學術研討會專 刊資料電子化、與國際交流、甲狀腺射頻消融術醫師認證、內分泌疾病專刊出版等等 許多重要任務。因應 COVID 疫情，我們的學術活動由實體會議增加了視訊會議、網路 學習等多元化的方式，讓會員參予的便利性及普及性大大提升。不只學會主辦的學術 活動，各地區會員群組辦理的學術活動也蓬勃發展。為了提升台灣在國際上的重要性 及知名度，理監事會通過向國際內分泌學會 (International Endocrine Society, ISE) 提出爭 取 2024 年國際內分泌大會主辦權的意願書。 學會屬於全體會員，謹期待我們的團結合作，能夠為台灣內分泌、糖尿病、新陳 代謝疾病之臨床診療及學術研究發展帶入更光輝永恆的發展。 謹祝 大家身體健康、萬事如意。 內分泌學會第 13、14 屆理事長 2022 年 3 月 8
Opening Remarks
理事長致詞 隨著台灣新冠肺炎疫情的緩解，防疫逐漸鬆綁，第 15 屆第 1 次內分泌學會暨糖尿 病學會會員大會暨學術研討會可望能以實體會議舉行。承襲以往規模，兩會均籌畫精 彩的學術新知供會員參考學習。在糖尿病學會方面，Plenary Lecture 請到英國 Prof. John Wilding，對熱門的肥胖議題於第 2 型糖尿病的角色與治療有深入探討；歐弘毅教授以內 分泌科醫師的觀點分享 NAFLD 及 Hepatokines 的研究成果。Meet the Professor 則邀請李弘 元教授聚焦在懷孕與高血糖的診斷與處理；另外在各個時段，則分別安排了糖尿病與各 器官的影響與共並關聯討論，例如 : DM and Brain、DM and Kidney、DM and CV disease、 DM and Bone、DM and Liver 以及 Lipid Guideline for Primary and Secondary Prevention 等。 而 β-cell 的基礎研究與治療、Young Investigation Research Report 也是重點，其中特別邀 請美國學者 Prof. Ken C.Chin 講述 DM and Hepatitis 的研究進展。 今年學會在眾多理監事及會員醫師的努力下分別完成了 2022 年第 2 型糖尿病與第 1 型糖尿病的治療指引，因此我們特別安排了 T1DM Guideline 的介紹與推廣，而隨著 T2DM 治療指引的更新，在各個時段也都會同步提供訊息給會員們學習。 今年與糖尿病衛教學會的聯合研討會主題是低血糖的探討與對策，其對糖尿病人的 重要性不言而喻，非常值得大家共同關注。 每年的論文徵稿，會員醫師們及各醫院皆踴躍投稿，相信源源不斷地用心與投入將 是學會持續進步的動力。最後祝各位會員們於疫情期間身心健康愉快，內分泌學會暨糖 尿病學會會務昌隆。
中華民國糖尿病學會理事長
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
Board of Directors
（依照姓氏筆劃排序）
The Endocrine Society of the Republic of China(Taiwan) President
曾芬郁 Fen-Yu Tseng
Standing Executive Board
王佩文 Pei-Wen Wang
蔡克嵩 Keh-Sung Tsai
Executive Board
王治元 Chih-Yuan Wang 施翔蓉 Shyang-Rong Shih 陳涵栩 Harn-Shen Chen 歐弘毅 Horng-Yih Ou
李亭儀 Annie Lee 陳思達 Szu-Tah Chen 劉鳳炫 Feng-Hsuan Liu 簡銘男 Ming-Nan Chien
Standing Control Board
張慶忠 Ching-Chung Chang
Control Board
林宏達 Hong-Da Lin
Secretary General
吳婉禎 Wan-Chen Wu
Deputy Secretary General
王舒儀 Shu-Yi Wang 林志弘 Chih-Hung Lin 陳思綺 Szu-chi Chen
林怡君 Yi-Jyun Lin 周振凱 Chen-Kai Chou 邱偉益 Wei-Yih Chiu 蘇登煌 Deng Huang Su
The Diabetes Association of the Republic of China(Taiwan) President
黃建寧 Chien-Ning Huang
Standing Executive Board
杜思德 Shih Te Tu 陳榮福 Jung-Fu Chen
楊偉勛 Wei-Shiung Yang 蔡世澤 Shih-Tzer Tsai
Executive Board
朱志勳 Chih-Hsun Chu 林時逸 Shih-Yi Lin 洪乙仁 Yi-Jen Hung 陳清助 Ching-Chu Chen 裴 馰 Dee Pei
李弘元 Hung-Yuan Li 林慶齡 Ching-Ling Lin 胡啟民 Chii-Min Hwu 曾慶孝 Chin-Hsiao Tseng 蘇景傑 Ching-Chieh Su
Standing Control Board
許惠恒 Wayne Huey-Herng Sheu
Control Board
何橈通 Low-Tone Ho 葉振聲 Tjin-Shing Jap
Secretary General
張恬君 Tien-Jyun Chang
Secretary
王俊興 Jun-Sing Wang 李建興 Chien-Hsing Lee 林嘉鴻 Chia-Hung Lin
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莊立民 Lee-Ming Chuang 戴東原 Tong-Yuan Tai 田凱仁 Kai-Jen Tien 林昆德 Kun-Der Lin 楊宜瑱 Yi-Sun Yang
Sponsors
The Endocrine Society and the Diabetes Association of the R.O.C (Taiwan) Would Like to Recongnize the Following for Their Support of the 43th Annual Meeting （依照中文筆劃排序） 力大圖書有限公司
The Leader Book Company Limited
中華海洋生技股份有限公司
Hi-Q Marine Biotech International Ltd
友華醫藥生技股份有限公司
Orient Europharma Co., Ltd.
台灣大塚製藥股份有限公司
Taiwan Otsuka Pharmaceutical Co., Ltd.
台灣田邊製藥股份有限公司
Taiwan Tanabe Seiyaku Co., Ltd.
台灣安晟信有限公司
Ascensia Diabetes Care Taiwan, Ltd.
台灣安進藥品有限公司
Amgen Taiwan Limited
台灣百靈佳殷格翰股份有限公司
Boehringer Ingelheim Taiwan Ltd.
台灣拜耳股份有限公司
Bayer Taiwan Company Ltd.
台灣諾和諾德藥品股份有限公司
Novo Nordisk Pharma (Taiwan) Ltd.
台灣諾華股份有限公司
Novartis (Taiwan) Co., Ltd.
台灣賽特瑞恩有限公司
Celltrion Healthcare Taiwan Ltd
台灣禮來股份有限公司
Eli Lilly And Company Taiwan
禾利行股份有限公司
Harvester Trading Co.,Ltd.
法商益普生股份有限公司台灣分公司
Ipsen Pharma Taiwan Branch (France)
美商亞培股份有限公司台灣分公司
Abbott Laboratories Services Llc Taiwan Branch (U.S.A.)
美商默沙東藥廠股份有限公司台灣分公司 Merck Sharp & Dohme (I.A.) Llc, Taiwan Branch 保佳生物科技股份有限公司
Bio-Check Laboratories Ltd.
華安藥品股份有限公司
Anko Pharma International (Taiwan) Co., Ltd.
新加坡商必帝股份有限公司
Becton Dickinson Holdings Pte. Ltd. Taiwan Branch (Singapore)
暉致醫藥股份有限公司
Viatris Pharmaceutical Company Limited.
嘉德藥品企業股份有限公司
Char Deh Drugs Enterprise Co.,Ltd.
臺灣阿斯特捷利康股份有限公司
Astrazeneca Taiwan Limited
賽諾菲股份有限公司
Sanofi Taiwan Co., Ltd 11
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The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
主持人、演講者列表 ( 外賓 ) 外賓
單位
Jae Hoon Chung, MD, PhD
Professor, Division of Endocrinology & Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Unit Chair, Education of Endocrinology & Metabolism Unit, Sungkyunkwan University School of Medicine Chairperson of the Board of Directors, Korean Thyroid Association Chief, Division of Endocrinology & Metabolism, Department of Medicine, Samsung Medical Center Director, Thyroid Center, Samsung Medical Center Immediate past-Chairman of Koran Endocrine Society(KES)
John Wilding, BM(Southampton), MRCP(UK), DM, (Southampton), FRCP
Professor of Medicine (Honorary Consultant Physician in Diabetes, Endocrinology and General Medicine) University of Liverpool and Liverpool University Hospitals NHS Foundation Trust
Ken C.Chiu, MD, PhD
Professor, Division of Endocrinology, Department of Internal Medicine, Harbor-UCLA Medical Center
Min-Hee Kim, MD, PhD
Assistant Professor Member, Committee of International Liaison, KES Department of Endocrinology, Eunpyeong St. Mary´s Hospital, The Catholic University of Korea
Peter Ebeling, AO, MBBS, MD, FRACP
President of ASBMR (American Society for Bone and Mineral Research)
Tae Hyuk Kim, MD, PhD
Associate Professor Sungkyunkwan University School of Medicine, Division of Endocrinology & Metabolism Department of Medicine, Samsung Medical Center (Samsung Seoul Hospital) ( 依照 First name 字母順序 )
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Moderator & Speaker
主持人、演講者列表 ( 國內 ) 毛羿傑 彰化基督教醫院內分泌新陳代謝科
沈峰志 高雄長庚紀念醫院內分泌暨新陳代謝科
王子源 中國醫藥大學附設醫院內分泌新陳代謝科
周宣彣 成大醫院內分泌新陳代謝科
王佩文 高雄長庚醫院新陳代謝科及核子醫學科
周振凱 高雄長庚紀念醫院內分泌暨新陳代謝科
王治元 臺大醫院內科部代謝內分泌科
官鋒澤 嘉義長庚紀念醫院血液腫瘤科
王俊興 臺中榮民總醫院內分泌暨新陳代謝科
林宏達 臺北榮民總醫院
王舒儀 彰化基督教醫院內分泌新陳代謝科
林志弘 臺大醫院內科部代謝內分泌科
王超然 林口長庚紀念醫院影像診療部
林怡君 榮陽安心診所
田凱仁 奇美醫院內分泌新陳代謝科
林怡瑄 林口長庚紀念醫院內分泌暨新陳代謝科
朱志勳 高雄榮民總醫院內分泌暨新陳代謝科
林昆德 高雄醫學大學醫學院內分泌新陳代謝內科
何橈通 臺北榮民總醫院
林亮羽 臺北榮民總醫院內分泌新陳代謝科
吳卓鍇 臺大醫院內科部心臟科
林冠宇 臺大醫院雲林分院代謝內分泌科
吳明勳 臺大醫院外科部
林思涵 雲林基督教醫院內分泌新陳代謝科
吳造中 臺大醫院內科部心臟科
林家宏 臺大醫院新竹分院代謝內分泌科
呂信邦 臺北榮民總醫院健康管理中心
林時逸 臺中榮民總醫院內分泌暨新陳代謝科
宋碧姍 成大醫院神經部
林嘉鴻 桃園長庚醫院內分泌新陳代謝科
李弘元 臺大醫院內科部代謝內分泌科
林漢傑 臺北榮民總醫院內科部胃腸肝膽科
李任光 臺大醫院心臟內科
林慶齡 國泰綜合醫院內科
李宇璇 臺中榮民總醫院內分泌新陳代謝科
林樹福 新北市土城醫院內分泌新陳代謝科
李亭儀 臺北市立萬芳醫院內分泌新陳代謝科
邱偉益 臺大醫院內科部代謝內分泌科
李建興 三軍總醫院內分泌新陳代謝科
姚珊汎 臺北榮民總醫院核醫部
李癸汌 台北榮民總醫院內科部胃腸肝膽科
施翔蓉 臺大醫學院內科部代謝內分泌科
李晏榮 林口長庚紀念醫院內分泌暨新陳代謝科
洪乙仁 三軍總醫院內分泌新陳代謝科
李健逢 奇美醫院醫學研究部
洪晧彰 高雄榮民總醫院內分泌新陳代謝科
李貽恒 成大醫院內科部
胡啟民 臺北榮民總醫院內分泌暨新陳代謝科
李燕晉 馬偕紀念醫院兒童內分泌科
胡朝榮 臺北醫學大學雙和醫院
杜思德 彰基醫療財團法人鹿港基督教醫院
高嘉宏 臺大醫院
杜業豐 成大醫院內分泌新陳代謝科
張以承 臺大醫院內科部
汪宜靜 臺大醫院護理部
張宏猷 林口長庚紀念醫院內分泌暨新陳代謝科
沈宜靜 臺中榮民總醫院內分泌暨新陳代謝科
張恬君 臺大醫院內科部代謝內分泌科
13
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
張 媚
臺灣大學
楊宏志 臺大醫院內科部
張雁翔 高雄長庚紀念醫院核子醫學科
楊宜瑱 中山醫學大學附設醫院內分泌暨新陳代謝科
張慶忠 中國醫藥大學附設醫院內科部
楊偉勛 臺大醫學院臨床醫學研究所
莊立民 臺大醫院內科部代謝內分泌科
溫振宇 臺大醫院內科部代謝內分泌科
莊峻鍠 林口長庚醫院內分泌暨新陳代謝科
葉振聲 為恭紀念醫院新陳代謝科
許惠恒 臺北榮民總醫院
裴 馰
許智堯 臺大新竹醫院代謝內分泌科
劉妙真 林口長庚紀念醫院內分泌暨新陳代謝科
郭仁富 彰化基督教醫院內分泌新陳代謝科
劉鳳炫 林口長庚紀念醫院內分泌暨新陳代謝科
郭錦松 臺北榮民總醫院內分泌暨新陳代謝科
歐弘毅 成大醫院內分泌暨新陳代謝科
陳天華 臺北榮民總醫院一般外科
蔡世澤 振興醫院營養治療科
陳沛隆 臺大醫院內科部代謝內分泌科
蔡克嵩 臺大醫院內科部及遠東診所
陳亭竹 臺大新竹醫院代謝內分泌科
蔡佩君 臺北榮民總醫院重症加護外科
陳亮恭 關渡醫院
蔡嘉仁 高雄長庚紀念醫院新陳代謝科
陳冠樺 義大醫院內分泌新陳代謝科
蔡慧珍 國家衛生研究院癌症研究所
陳思達 林口長庚醫院內分泌暨新陳代謝科
鄭建興 臺大醫院神經部
陳涵栩 臺北榮民總醫院內分泌暨新陳代謝科
鄭為仁 林口長庚紀念醫院中醫部
陳清助 中國醫藥大學附設醫院內科部新陳代謝科
鄭凱比 成大醫院內分泌新陳代謝科
陳榮福 高雄長庚紀念醫院內分泌暨新陳代謝科
鄭凱倫 中山醫學大學附設醫院醫學影像部
陳維常 國泰醫院內分泌新陳代謝科
鄭媚方 臺大醫院核子醫學部
曾芬郁 臺東基督教醫院內分泌新陳代謝科
戴東原 臺北仁濟醫院
曾慶孝 臺大醫院內科部代謝內分泌科
鍾芷萍 臺北榮民總醫院神經內科
曾耀賢 童綜合醫院新陳代謝科
簡榮南 林口長庚紀念醫院
湯頌君 臺大醫院神經部
簡銘男 臺北馬偕紀念醫院內分泌新陳代謝科
童怡靖 臺大醫院小兒內分泌科
闕士傑 臺大醫院泌尿部
馮盈勳 奇美醫院血液腫瘤科
顏若芳 臺大醫院核子醫學部
黃兆山 林口長庚紀念醫院內分泌暨新陳代謝科
魏以宣 臺大醫院眼科部
輔大醫院新陳代謝科
黃志富 高雄醫學大學附設中和紀念醫院肝膽胰內科 羅福松 林口長庚紀念醫院兒童內分泌暨遺傳科 黃金洲 臺北榮民總醫院心臟內科
羅學榮 國泰醫院內分泌新陳代謝科
黃建寧 中山醫學大學
蘇景傑 蘇景傑診所
黃柏勳 臺北榮民總醫院心臟內科
14
( 依照姓氏筆畫順序 )
Agenda
社團法人中華民國內分泌暨糖尿病學會 第 15 屆第 1 次會員大會暨學術研討會 日期：民國 111 年 3 月 19-20 日／地點：臺大醫院國際會議中心
March 19, 2022
PL1: Plenary Lecture 1
【101 Room】 Time 13:20-13:25 PL-1 13:25-14:05
Topic OPENING
Time
Topic
曾芬郁
Moderator 黃建寧
OBESITY PHARMACOTHERAPY – WHICH TREATMENTS REALLY WORK?
John Wilding
黃建寧
PL3: Plenary Lecture 3
【101 Room】 Time
PL-3 10:05-10:45
Speaker
OPENING
March 20, 2022
10:00-10:05
王佩文
PL2:Plenary Lecture 2
【101 Room】
PL-2 14:10-14:50
Moderator 曾芬郁
MANAGEMENT OF DIFFERENTIATED THYROID CANCER: CURRENT GLOBAL CONSENSUS AND SINGLEINSTITUTIONAL EXPERIENCES
March 10,2018
14:05-14:10
Speaker
Topic
Speaker
OPENING WHAT I HAVE LEARNED FROM PRIMARY ALDOSTERONISM THESE YEARS?
Moderator 蔡克嵩
闕士傑
蔡克嵩
15
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
March 20, 2022
PL4: Plenary Lecture 4
【101 Room】 Time 13:35-13:40 PL-4 13:40-14:20
March 19, 2022 【401 Room】 Time MTP-E 17:00-18:00
March 19, 2022 【301 Room】 Time MTP-D 17:00-18:00
16
Topic
Speaker
Moderator
OPENING
許惠恒
NON-ALCOHOLIC FATTY LIVER DISEASE AND HEPATOKINES - AN ENDOCRINOLOGIST PERSPECTIVE
歐弘毅
許惠恒
MTP-E:Meet the Professor Topic RECENT ADVANCES AND UNMET NEED OF NUCLEAR MEDICINE IMAGING AND THERAPY IN ENDOCRINOLOGY
Speaker Moderator 顏若芳
林宏達
MTP-D:Meet the Professor Topic REVIEW AND UPDATE FOR THE DIAGNOSIS AND MANAGEMENT OF HYPERGLYCEMIA IN PREGNANCY
Speaker Moderator 李弘元
蔡世澤
Agenda
March 19, 2022
DAROC-TADE Joint Symposium
【101 Room】 Time
Topic
08:00~08:20
報到
08:20~08:30
OPENING
Speaker Moderator
王治元
DAROC-TADE1 08:30~09:10
察覺糖尿病患發生嚴重低血糖症背 後潛藏的警訊
沈峰志
陳榮福
DAROC-TADE2 09:10~09:50
「低血糖不自覺」是危機還是轉機？ 預防及處置的有效策略
洪晧彰
歐弘毅
09:50~10:10
休息
DAROC-TADE3 10:10-10:50
如何聰明使用連續血糖監測來偵知 並預測低血糖？
杜業豐
杜思德
DAROC-TADE4 10:50~11:30
解開低血糖枷鎖 ：低血糖的社會心 理影響與對策
張 媚
黃建寧
11:30~11:50
PANEL DISCUSSION
許惠恒 黃建寧 王治元
11:50-12:00
CLOSING REMARKS
王治元
17
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
March 19, 2022 【401 Room】
SE1: Endocrine Symposium 1 Thyroid Eye Disease
Time 15:20-15:25
Topic
Speaker Moderator
OPENING
SE1-1 15:25-15:55
THE PATHOPHYSIOLOGY OF THYROID EYE DISEASE
周宣彣
SE1-2 15:55-16:25
THYROID EYE DISEASE: PERSPECTIVES FROM AN OPHTHALMOLOGIST´S POINT OF VIEW
魏以宣
REVIEW OF 2021 EUGOGO CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF GRAVES´ ORBITOPATHY
陳冠樺
SE1-3 16:25-16:55
16:55-17:00
March 19, 2022 【402AB Room】
PANEL DISCUSSION
All
SE2: Endocrine Symposium 2 Endocrinology and Aging
Time 15:20-15:25
陳思達 施翔蓉
Topic
Speaker
OPENING REMARK
SE2-1 15:25-15:55
ENDOCRINOLOGY AND AGING
許智堯
SE2-2 15:55-16:25
中醫觀點看抗老化
鄭為仁
SE2-3 16:25-16:55
SKELETAL MUSCLE AS THE ENDOCRINE ORGAN OF AGING
陳亮恭
16:55-17:00
18
Moderator
PANEL DISCUSSION
All
王治元 歐弘毅
Agenda
March 19, 2022 【202 Room】 Time 15:20-15:25 SE3-1 15:25-15:55
SE3: Endocrine Symposium 3 Pituitary
Topic
Speaker Moderator
OPENING REMARK CLINICAL PRESENTATION AND MANAGEMENT OF HYPOPHYSITIS
林冠宇
SE3-2 15:55-16:25
TRAUMATIC BRAIN INJURYASSOCIATED HYPOPITUITARISM
毛羿傑
SE3-3 16:25-16:55
CARDIOVASCULAR HEALTH IN PATIENTS WITH PITUITARY TUMORS
王俊興
16:55-17:00
March 20, 2022 【101 Room】 Time 08:00-08:05
PANEL DISCUSSION
All
SE4: Endocrine Symposium 4 COVID-19 & Endocrine Diseases (case sharing) Topic
Speaker Moderator
OPENING REMARK
SE4-1 08:05-08:35
DO COVID VACCINES AFFECT MENSTRUATION?
林思涵
SE4-2 08:35-09:05
NEW ONSET OF GRAVES´ DISEASE WITH THYROID STORM AFTER ADENOVIRUS-VECTORED COVID-19 VACCINE
羅學榮
SE4-3 09:05-09:35
COVID-19 AND ADRENAL INSUFFICIENCY
溫振宇
09:35-09:40
陳涵栩 張慶忠
PANEL DISCUSSION
曾芬郁 林宏達
All
19
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
March 20, 2022 【301 Room】 Time 08:00-08:05
SE5: Endocrine Symposium 5 Hyperparathyroidism
Topic
Speaker Moderator
OPENING REMARK
SE5-1 08:05-08:35
HYPERPARATHYROIDISM-DIFFERENTIAL ( 副甲狀腺機能亢進鑑別診斷 )
李晏榮
SE5-2 08:35-09:05
HYPERPARATHYROIDISM IN MULTIPLE ENDOCRINE NEOPLASIA
杜業豐
SE5-3 09:05-09:35
LITHIUM-INDUCED HYPERPARATHYROIDISM AND HYPERCALCEMIA
邱偉益
09:35-09:40
March 20, 2022 【402CD Room】 Time 08:00-08:05
PANEL DISCUSSION
蔡克嵩 李亭儀
All
SE6: Endocrine Symposium 6
Pheochromocytoma and Paraganglioma (PPGL) Topic
Speaker Moderator
OPENING REMARK
SE6-1 08:05-08:35
GENETICS AND BIOLOGY OF PHEOCHROMOCYTOMA AND PARAGANGLIOMA (PPGL)
陳沛隆
SE6-2 08:35-09:05
PHEOCHROMOCYTOMA AND PARAGANGLIOMA (PPGL)DIAGNOSIS AND PERI-OPERATIVE MANAGEMENT
林怡瑄
SE6-3 09:05-09:35
RECENT ADVANCE IN THE MANAGEMENT OF METASTATIC PHEOCHROMOCYTOMA AND PARAGANGLIOMA
林亮羽
09:35-09:40 20
PANEL DISCUSSION
張慶忠 劉鳳炫
All
Agenda
March 20, 2022 【401 Room】 Time 14:40-14:45
SE7: Endocrine Symposium 7 Thyroid Cancer
Topic
Speaker Moderator
OPENING REMARK
SE7-1 14:45-15:15
THE ROLE OF INTEGRATED IMAGING IN THE MANAGEMENT OF THYROID CANCER
張雁翔
SE7-2 15:15-15:45
TRANSORAL ENDOSCOPIC THYROIDECTOMY FOR THYROID DISEASE
吳明勳
SE7-3 15:45-16:15
PRECISION MEDICINE IN METASTATIC THYROID CANCER
官鋒澤
16:15-16:20
March 20, 2022 【402AB Room】 Time 14:40-14:45
PANEL DISCUSSION
All
SE8: Endocrine Symposium 8 Neuroendocrine Tumors Topic
Speaker Moderator
OPENING REMARK
SE8-1 14:45-15:15
THE CLINICAL UTILITY OF MOLECULAR PROFILING ON ENDOCRINE TUMORS
李健逢
SE8-2 15:15-15:45
IN THE ERA OF THERANOSTICSPEPTIDE RECEPTOR RADIONUCLIDE THERAPY (PRRT) IN NEUROENDOCRINE TUMORS (NETS)
鄭媚方
SE8-3 15:45-16:15
TARGET THERAPY FOR NEUROENDOCRINE TUMORS
蔡慧珍
16:15-16:20
王佩文 林怡君
PANEL DISCUSSION
歐弘毅 簡銘男
All
21
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
March 20, 2022 【205 Room】 Time 14:40-14:45
SE9: Endocrine Symposium 9 Rare Endocrine Diseases Topic
Speaker Moderator
OPENING REMARK
SE9-1 14:45-15:10
INTRACARDIAC PARAGANGLIOMA
陳亭竹
SE9-2 15:10-15:35
MALT LYMPHOMA OF BOTH THYROID AND ADRENAL PRESENTING WITH ADRENAL INSUFFICIENCY
曾耀賢
SE9-3 15:35-16:00
CONCOMITANT ECTOPIC CUSHING SYNDROME AND ZOLLINGER-ELLISON SYNDROME IN A POSTPARTUM WOMAN
王子源
PARATHYROID CARCINOMA WITH PRIMARY HYPERPARATHYROIDISM POST SURGICAL INTERVENTION WITH RECURRENCE AND TRACHEAL INVASION POST RADIOFREQUENCY ABLATION OF THYROID TUMOR: A CASE REPORT
陳維常
SE9-4 16:00-16:25
16:25-16:30
March 19, 2022 【301 Room】 Time 15:20-15:25
PANEL DISCUSSION
陳涵栩 施翔蓉
All
SD1: DM symposium 1 DM and Brain
Topic
Speaker Moderator
OPENING REMARK
鄭建興
SD1-1 15:25-15:55
OVERVIEW OF CEREBROVASCULAR DISEASE AND DM
湯頌君
鄭建興
SD1-2 15:55-16:25
BRAIN SMALL VESSEL DISEASE AND DIABETES
鍾芷萍
林慶齡
SD1-3 16:25-16:55
DEMENTIA IN DIABETES PATIENTS
宋碧姍
胡朝榮
All
胡朝榮
16:55-17:00 22
PANEL DISCUSSION
Agenda
March 19, 2022 【402CD Room】
SD2: DM Symposium 2
DM and Kidney （Goal 50 : 良程控糖保腎力計畫回顧與展望）
Time 15:20-15:25
Topic
Speaker Moderator
OPENING
黃建寧
SD2-1 15:25-15:40
REVIEW AND PROSPECTIVE OF GOAL 50 PROJECT
張恬君
黃建寧
SD2-2 15:40-16:05
GOAL50「良程控糖保腎力 : 糖尿病腎病變 整合照護第一階段成果
王俊興
洪乙仁
SD2-3 16:05-16:25
2022 UPDATE IN TAIWAN GUIDELINE OF DIABETES KIDNEY DISEASE
林昆德
裴 馰
SD2-4 16:25-16:45
如何透過團隊照護提升糖尿病腎病變整合照護 品質
汪宜靜
王治元
All
王治元
16:45-17:00
March 19, 2022 【203 Room】
PANEL DISCUSSION
SD3: DM Symposium 3
DM and Hepatitis & Young Investigator Research Report
Time 15:20-15:25
Topic OPENING
SD3-1 15:25-15:55
DIABETES AND HEPATITIS
SD3-2 15:55-16:25
SD3-3 16:25-16:55 16:55-17:00
Speaker
Moderator 莊立民
Ken C.Chiu
莊立民
A NOVEL ALDH2 ACTIVATOR AD9308 IMPROVES DIASTOLIC AND SYSTOLIC MYOCARDIAL FUNCTIONS IN STREPTOZOTOCININDUCED DIABETIC MICE
張以承
蘇景傑
非營養性甜味劑對妊娠期的影響
鄭凱比
陳清助
PANEL DISCUSSION
陳清助 23
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SD4: DM Symposium 4
March 20, 2022
DM and Cardiovascular Disease
【401 Room】 Time 08:00-08:05
Topic
Speaker
OPENING
Moderator 朱志勳
SD4-1 08:05-08:35
PATHOPHYSIOLOGY OF CARDIOVASCULAR DISEASE IN DIABETES
呂信邦
朱志勳
SD4-2 08:35-09:05
UPDATE IN THE TREATMENT OF ASCVD IN DIABETES PATIENTS
田凱仁
林時逸
SD4-3 09:05-09:35
UPDATE IN THE TREATMENT OF HEART FAILURE IN DIABETES PATIENTS
吳卓鍇
楊偉勛
All
楊偉勛
09:35-09:40
March 20, 2022 【402AB Room】 Time 08:00-08:05
PANEL DISCUSSION
SD5: DM Symposium 5
Lipid Guideline for Primary and Secondary Prevention Topic
Speaker
OPENING REMARK
Moderator 戴東原
SD5-1 08:05-08:35
PATHOPHYSIOLOGY OF DYSLIPIDEMIA
楊偉勛
戴東原
SD5-2 08:35-09:05
2022 TAIWAN LIPID GUIDELINES FOR PRIMARY PREVENTION
黃柏勳
葉振聲
SD5-3 09:05-09:25
LIPID GUIDELINES FOR SECONDARY PREVENTION
吳造中
曾慶孝
All
曾慶孝
09:25-09:30
24
PANEL DISCUSSION
Agenda
SD6: DM Symposium 6
March 20, 2022 【205 Room】
Beta Cell Centric Approach of Diabetes Treatment
Time 08:00-08:05
Topic
Speaker
OPENING
Moderator 莊峻鍠
SD6-1 08:05-08:35
PHARMACOLOGIC APPROACH TO AMELIORATE GLUCOLIPOTOXICITY OF PANCREATIC BETA CELLS
張恬君
莊峻鍠
SD6-2 08:35-09:05
STUDY OF THE THERAPEUTIC EFFECT OF MESENCHYMAL STEM CELLS IN TYPE 1 DIABETES
陳天華 / 蔡佩君
何橈通
SD6-3 09:05-09:35
FUNCTIONAL AND MECHANISTIC STUDIES OF PDIA4 IN TYPE 2 DIABETES
楊文欽
莊立民
09:35-09:40
March 20, 2022 【101 Room】 Time
CLOSING
莊立民
SD7: DM Symposium 7 Type 1 DM Guideline
Topic
Speaker
Moderator
SD7-1 14:40-14:55
NTRODUCTION AND RATIONALE OF THE TYPE 1 DM GUIDELINE GUIDELINES
沈宜靜
胡啟民
SD7-2 14:55-15:20
DIAGNOSIS OF TYPE 1 DIABETES MELLITUS
林嘉鴻
李燕晉
SD7-3 15:20-15:50
SPECIAL ATTENTION FOR PEDIATRIC TYPE 1 DIABETES PATIENTS
童怡靖
羅福松
SD7-4 15:50-16:15
CTDA 2021 CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF TYPE 1 DIABETES MELLITUS: EXECUTIVE SUMMARY
張恬君
黃建寧
All
黃建寧
16:15-16:20
PANEL DISCUSSION
25
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The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SD8: DM Symposium 8
March 20, 2022
DM and Bone
【301 Room】 Time 14:40-14:45
Topic
Speaker
OPENING
Moderator 黃兆山
SD8-1 14:45-15:15
ASSESSING BONE MINERAL DENSITY AND FRACTURE RISK IN PATIENTS WITH DIABETES
王超然
蔡克嵩
SD8-2 15:15-15:45
ROLE OF BONE MICROSTRUCTURE IN DIABETES BONE FRAGILITY
郭仁富
杜思德
SD8-3 15:45-16:15
IMPLICATIONS FOR OSTEOPOROSIS TREATMENT IN DIABETIC PATIENTS
蔡嘉仁
陳榮福
All
陳榮福
16:15-16:20
PANEL DISCUSSION
SD9: DM Symposium 9
March 20, 2022
DM and Liver
【402CD Room】 Time 14:40-14:45
Topic
Speaker
OPENING
Moderator 林漢傑
SD9-1 14:45-15:15
VIRAL HEPATITIS AND DIABETES
楊宏志
李弘元
SD9-2 15:15-15:45
NON-ALCOHOLIC FATTY LIVER DISEASE
黃志富
何橈通
SD9-3 15:45-16:15
RECENT ADVANCES IN THE DEVELOPMENT OF TREATMENT FOR NON-ALCOHOLIC FATTY LIVER DISEASE
李癸汌
高嘉宏
All
高嘉宏
16:15-16:20
26
PANEL DISCUSSION
Agenda
March 19, 2022 【401 Room】
ESROC – KES Joint Symposium
Time 10:00-10:05
Topic
Speaker Moderator
OPENING REMARKS
ESROC- 10:05-10:30 KES-1
SAFETY OF ANTITHYROID DRUG THERAPY IN PREGNANCY (VIDEO)
Tae Hyuk Kim
ESROC- 10:30-10:55 KES-2
EPIDEMIOLOGY, SURVIVAL AND DEATH CAUSES OF THYROID CANCER IN TAIWAN, AND BEYOND (ON SITE)
林樹福
ESROC- 10:55-11:20 KES-3
ASSOCIATION OF METABOLIC CHANGES WITH SUBTLE DIFFERENCE IN THYROID FUNCTION: FINDINGS FROM KOREAN NATIONAL HEALTH AND NUTRITIONAL EXAMINATION AND SURVEY (KNHANES) (VIDEO)
ESROC- 11:20-11:45 KES-4
SERUM FIBROBLAST GROWTH FACTOR 23 AND MINERAL METABOLISM IN PATIENTS WITH EUTHYROID GRAVES’ DISEASES: A CASE-CONTROL STUDY (ON SITE)
11:45-11:55
CANEL DISCUSSION (Q & A ONLINE)
11:55-12:00
CLOSING REMARKS
全體
Thyroid RFA Hand-on
【402AB Room】 Time
Workshop-1 09:30-11:30
林家宏
Workshop
March 19, 2022
09:00-09:30
曾芬郁 & Jae Hoon Chung Min-Hee Kim
Topic
Speaker Moderator
報到 HAND ON ( 台大微創手術訓練中心 )
吳明勳 鄭凱倫 李宇璇 27
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
LS: Lunch Symposium
March 10-11, 2018 Room
101
301
401
402AB
402CD
202
203
205
403
容納人數
600 人
220 人
220 人
200 人
200 人
80 人
80 人
80 人
60 人
3/19( 六 ) 12:00-13:00
LS-1
LS-2
LS-4
LS-5
LS-7
LS-9
LS-8
安進
諾和諾德
大塚
益普生
暉致
默沙東
拜耳
LS-14
3/20( 日 ) LS-10 12:30-13:30 諾和諾德
March 19, 2022
LS-11
LS-12
LS-13
友華
台田
諾華
華安
LS-6 禮來 百靈佳
LS-17
LS-15
阿斯特 捷利康
百靈佳 殷格翰
Topic
LS-16 賽諾菲
Speaker
Moderator
LS-1
安進
OSTEOPOROSIS, THE HIDDEN CHRONIC CONCERN OF YOUR PATIENTS
Peter Ebeling
陳榮福
LS-2
諾和 諾德
以終為始的高效胰島素治療新觀點
張宏猷
蔡世澤
LS-4
大塚
OPTIMAL ANTIPLATELET THERAPY FOR ISCHEMIC STROKE SECONDARY PREVENTION
宋碧姍
張恬君
LOWER EXTREMITY ARTERIAL DISEASE IN DM PATIENTS: DIAGNOSIS AND TREATMENT
李任光
胡啟民
LS-5
益普生
EMERGING TARGETED THERAPIES FOR DIFFERENTIATED THYROID CANCER
施翔蓉
馮盈勳
LS-6
禮來 百靈佳
DIABETES AND HEART FAILURE: PRACTICE-CHANGING TRIALS IN HEART FAILURE AND KIDNEY DISEASE WITH SGLT2 INHIBITORS
李弘元
黃建寧
LS-7
暉致
BIG 3, 2 EFFECTS, YOUR 1ST CHOICE IN HYPERTENSION - WHAT CAN WE OFFER WITH NCD ?
郭錦松
歐弘毅
28
Agenda LS-8
拜耳
HOW TO MAXIMIZE THE TREATMENT OUTCOME FOR NEXAVAR IN RRDTC: CGMH-LK EXPERIENCE SHARING
劉妙真
王治元
LS-9
默沙東
SEE ASIA - SITAGLIPTIN AND ERTUGLIFLOZIN EFFICACY IN ASIAN T2DM PATIENTS
林嘉鴻
陳清助
TOPIC
Speaker
Moderator
March 20, 2022 LS-10
諾和 諾德
NEW TREATMENT OPTION FOR YOUR T2DM PATIENTS, THE FIRST AND ONLY ORAL GLP-1 RA IN THE WORLD
楊宜瑱
黃建寧
LS-11
友華
RECENT PROGRESS OF LIPID LOWERING THERAPY
李貽恒
杜思德
LS-12
台田
PRIMARY PREVENTION OF LIPID TREATMENT IN TAIWAN - WHAT SHOULD WE FOCUS IN 2022
黃金洲
許惠恒
LS-13
諾華
NEW ERA OF NET TREATMENT : PEPTIDE RECEPTOR RADIONUCLIDE THERAPY
姚珊汎
施翔蓉
LS-14
華安
消滅糖尿病患者中的 HCV 病毒，現在正是 時候 !
簡榮南
陳榮福
LS-15
百靈佳 殷格翰
360。EFFICACY : WHAT IS THE STRONGEST EFFICACYFOR YOUR T2D PATIENTS ?
曾耀賢
林慶齡
LS-16
賽諾菲
DOSE GLYCEMIC VARIABILITY HAVE A ROLE IN PEOPLE WITH TYPE 2 DIABETES
林怡瑄
楊偉勛
REMISSION OF TYPE 2 DIABETES FOLLOWING INTENSIVE TREATMENT WITH DIFFERENT APPROACHES
田凱仁
楊偉勛
TRANSLATING DIABETES AND KIDNEY DISEASE CLINICAL EVIDENCE INTO REAL WORLD PRACTICE
王治元
胡啟民
LS17
阿斯特 捷利康
29
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
March 19-20, 2022 【3F Walkway】
AP: 2021 Outstanding Research Award 題 目
作者
傑出研究獎 AR-1
THE MOLECULAR MECHANISMS ON PROLIFERATION, INSULIN SECRETORY FUNCTION AND SURVIVAL OF ISLET Β CELLS
March 19-20, 2022 【3F Walkway】
張恬君
AP: 2021 Outstanding Paper Award 題 目
作者
內分泌暨糖尿病學會優秀論文獎 AP-1
EFFECT OF A NOVEL MACROPHAGE-REGULATING DRUG ON WOUND HEALING IN PATIENTS WITH DIABETIC FOOT ULCERS: A RANDOMIZED CLINICAL TRIAL
黃禹堯
AP-2
THERAPEUTIC INHIBITION OF POLO-LIKE KINASES IN ANAPLASTIC THYROID CANCER
林樹福
諾和諾德優秀論文獎 AP-3
REDUCED EXPRESSION OF UROKINASE PLASMINOGEN ACTIVATOR IN BROWN ADIPOSE TISSUE OF OBESE MICE MODELS
吳忠擇
AP-4
HIGH-MOLECULAR-WEIGHT HYALURONIC ACID INHIBITS IL-1Β-INDUCED SYNOVIAL INFLAMMATION AND MACROPHAGE POLARIZATION THROUGH THE GRP78-NFΚB SIGNALING PATHWAY
李建興
30
Agenda
March 19, 2022 【402AB Room】
OE: Oral Presentation-Endocrine
Time
Topic
Speaker Moderator
OE-1
17:00-17:10
亞洲腎上腺癌病患的臨床和病理分析 : 單一 醫學中心經驗
蔡文瑄
OE-2
17:10-17:20
尿液外泌體生物指標 ANGIOPOIETIN-1 和 TIMP（金屬蛋白酶組織抑製劑）作為分 化良好的甲狀腺癌的預後預
王治元
OE-3
17:20-17:30
分化型甲狀腺癌患者完全緩解後發生遠端 轉移之預後
許嘉容
OE-4
17:30-17:40
LENVATINIB 在台灣甲狀腺癌患者中的真 實療效和安全性
張雅筑
OE-5
17:40-17:50
從臨床經驗回顧淋巴結外侵犯對於甲狀腺 癌病人的治療影響 - 南部醫學中心的經驗分 享
蔡加睿
OE-6
17:50-18:00
長鏈非編碼核糖核酸 HOTAIR 於甲狀腺乳 突癌中調節細胞惡性表徵並於表觀遺傳上 抑制 DLX1 基因
郭俸志
March 19, 2022 【402CD Room】
李亭儀 簡銘男 劉鳳炫
OD: Oral Presentation-Diabetes
Time
Topic
Speaker Moderator
OD-1
17:00-17:10
成纖維細胞生長因子 21 與 第 2 型糖尿病 患者的腎臟預後相關性研究
張立心
蘇景傑
OD-2
17:10-17:20
全民健康保險修訂糖尿病藥品給付規定對 於心血管疾病預防之成本效果分析：以 DPP-4/SGLT2 抑制劑之複方製劑為例
許智堯
蘇景傑
OD-3
17:20-17:30
第 2 型糖尿病長期患者的晝夜節律失調與 發生大小血管併發症的風險具有相關性 : 台 灣糖尿病登錄資料
何禮如
楊宜瑱
31
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
OD-4
17:30-17:40
粒線體未折疊蛋白反應以及老化在糖尿病 的表現
沈峰志
楊宜瑱
OD-5
17:40-17:50
利用連續型血糖監測儀評估自口服降血糖 藥物轉換針劑治療之第二型糖尿病病人血 糖狀況
黃君睿
林昆德
OD-6
17:50-18:00
DM-HEART STUDY 學數據初步調查： NT-PROBNP 在第 2 型糖尿病心臟衰竭中 的角色
溫振宇
林昆德
March 19-20,2022 【3F Walkway】
PE: Poster Presentation-Endocrine 主持人 : 王舒儀、周振凱、林志弘 評分時間 : 2022/3/19( 六 ) 14:50 – 15:20 題 目
第一作者
PE-1
碘營養狀況與 BRAFV600E 突變與甲狀腺乳頭狀癌的相關性探討
林彥宇
PE-3
COVID-19 疫苗接種後致甲狀腺毒症案例
王偉倫
PE-4
病例報告 : 血漿置換術治療甲狀腺風暴合併後天性血友病
林育玲
PE-5
甲狀腺毒性週期性麻痺症治療的新策略
廖哲頡
PE-6
分化型甲狀腺癌於縱膈腔轉移之預後分析
賴昆佑
PE-7
次發性無月經女性施打 COVID-19 疫苗後產生突破性出血 : 個案報 告與文獻回顧
林子健
PE-8
抗甲狀腺素與乳癌的關係在女性病人身上 : A Case-Control Study
曾盈瑜
PE-9
IgG4 相關腦下腺炎以中樞性尿崩症表現：案例報告
歐道昇
PE-10
術前治療性血漿置換術於 methimazole 引致嚴重骨髓抑制之甲亢病 人的治療應用 : 案例報告
潘立昕
PE-11
北台灣市售乳品及植物奶碘濃度測定
張采瑩
32
Agenda
題 目
第一作者
PE-12
以糖尿病酮酸血症為表現之肢端肥大症 – 病例報告
黃柏瑜
PE-13
一個稀少的臨床案例 : 未控制的次發性甲狀腺功能低下造成黏液水腫 性昏迷
許家臻
PE-14
一個不尋常的腎上腺淋巴癌案例表現自主皮質醇分泌
郭俊亨
PE-15
未表現庫欣氏症特徵之促腎上腺皮質激素腺瘤合併腦下垂體中風：病 例報告
蘇冠伃
PE-16
探討台灣甲狀腺結節盛行率以及基層診所執行甲狀腺細針穿刺檢查成 效
陳冠宇
PE-17
病例報告 : 接種 SARS-CoV-2 疫苗後引發的亞急性甲狀腺炎
何立中
PE-18
以溢乳為表現的顱咽管瘤 - 病例報告
鄭喬比
PE-19
亞急性甲狀腺炎合併葛瑞夫茲病患者的 Tc-99m 甲狀腺掃描之病例報 告
邱依婷
PE-20
利用連續尿液樣本評估個人碘營養狀態
楊舜傑
PE-21
甲狀腺切除術後併發霍納氏症候群 - 兩病例報告及文獻回顧
蔡雨言
PE-22
接種 COVID-19 疫苗後的亞急性甲狀腺炎 : 個案報告和文獻回顧
羅元豪
PE-23
NT-proBNP（N- 末端腦鈉肽前體）預測葛瑞夫氏甲亢疾病活性中的 潛在角色：初報
施文蕙
PE-24
纖維母細胞生長因子 23 經由磷脂酶 C 介導的鈣訊號傳導刺激心臟纖 維母細胞之活性
李亭衛
PE-25
葛瑞夫茲氏病年輕女性患者服用利甲錠誘導的胰島素自身免疫性低血 糖
陳怡樺
PE-26
鋰鹽引致腎源性尿崩症之案例報告
潘立昕
PE-27
副甲狀腺瘤合併無症狀高血鈣及 甲狀腺乳突癌 : 病例報告與文獻回顧
張珈銓
PE-28
病例報告 : 產後甲狀腺炎
胡菁芸
PE-29
甲狀腺麴菌膿瘍感染 : 病例報告
盧翰生 33
43
The
rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
題 目
第一作者
PE-30
章魚壺心肌症合併甲狀腺機能亢進之案例報告
吳尚賢
PE-31
病例報告 : 甲狀腺癌基因突變檢測指引非典型細胞學之甲狀腺結節的 處置
蔡依靜
PE-32
兒茶酚胺導致心肌炎併心因性休克在嗜鉻細胞瘤與神經纖維瘤病
李麗青
PE-33
乙型地中海貧血病患的內分泌疾病：個案報告
許靖玫
March 19-20,2022 【3F Walkway】
PD: Poster Presentation-Diabetes 主持人 : 林嘉鴻、王俊興、李建興 評分時間 : 2022/3/19( 六 ) 14:50 – 15:20 題 目
第一作者
PD-1
類升糖素胜肽 -1 受體促效劑減少糖尿病患焦慮症的風險 : 以全國人 口為對象之世代研究
蔡文瑄
PD-2
多發性胰島素瘤：病例報告
黃欣寧
PD-3
探討非侵入性腦刺激術對於減重的效果與接受度 : 網絡統合分析
曾秉彥
PD-4
臺灣第 2 型糖尿病患者使用 DPP4 抑制劑與骨質疏鬆風險的關係
張家豪
PD-5
第一型糖尿病合併胃輕癱病人經外科治療後症狀明顯改善 - 病例報告
李蘊琪
PD-6
愛克利導致的糖尿病酮酸中毒 : 一個案例報告
李宜鴻
PD-7
老年人每日牛奶攝取量與認知障礙之相關風險
賴韻如
PD-8
糖尿病族群 C 型肝炎血清陽性盛行率 : 南臺灣單一醫學中心研究
林麗珊
PD-9
內生性 C 型肝炎病毒非結構蛋白第 4 型 (NS4) 透過干擾肝臟維生素 A 細胞訊息路徑導致胰島素抗阻性
林碧珍
PD-10
內生性 B 型肝炎病毒核心蛋白造成胰島素分泌損傷與胰島纖維化
林碧珍
PD-11
ANGPTL4 在妊娠糖尿病致病機轉的角色
郭俊亨
34
Agenda
題 目
第一作者
PD-12
ANGPTL8 蛋白在人類網膜脂肪細胞表現與 BMI 相關性之探討
黃則穎
PD-13
免疫檢查點抑制劑 : 造成胰島素依賴之糖尿病的新興成因
魏虹惠
PD-14
免疫治療相關副作用引起之其他類型糖尿病：病例報告
陳瀅宇
March 19-20,2022 【3F Walkway】
BP 廠商論文壁報展示 題 目
投稿單位
BP-1
TIRZEPATIDE 相較於 DEGLUDEC 胰島素在第二型糖尿病病患肝臟脂 台灣禮來 肪和腹部脂肪之比較 (SURPASS-3 MRI) 有限公司
BP-2
TIRZEPATIDE 相較於 DEGLUDEC 胰島素在第二型糖尿病病人使用連 台灣禮來 續血糖監測儀紀錄之血糖控制之比較 (SURPASS-3 CGM) 有限公司
BP-3
使用腸泌素的台灣第二型糖尿病病人的臨床特徵：真實世界研究
台灣禮來 有限公司
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PL-1
MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA: CURRENT GLOBAL CONSENSUS AND SINGLE-INSTITUTIONAL EXPERIENCES
分化型甲狀腺癌處置：現狀國際共識及經驗分享 PEI-WEN WANG 王佩文 Department of Internal Medicine and Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 長庚大學暨高雄長庚醫院內科系新陳代謝科及核子醫學科
Based on improved knowledge of the oncobiology of differentiated thyroid cancer (DTC) and on advances in therapy, considerable changes have occurred in the management of DTC in the recent decades. However, controversies still exist in current approach of the disease. Optimal management of DTC requires an individualized risk assessment. Traditional TNM staging system (stage I–IV) is used to classify risks of disease-specific survival. The American Thyroid Association staging systems (low, intermediate, high risk) evaluated after operation and first 131I ablation is designed to better predict the risk of persistence/recurrence. Moreover, dynamic risk assessment based on the response to initial therapy (excellent response, biochemically incomplete, indeterminate and structurally incomplete), usually determined 6–24 months after the first 131I ablation, is an effective tool to personalize the treatment plan. Further, judicious incorporation of molecular theranostics has the potential to devise patient-specific intervention. Most cases of DTC are curable with the use of surgery and radioactive iodine (RAI). The first administered activity of 131I after thyroidectomy should be used with the specific goals: to destroy (i) residual presumably benign thyroid tissue, (ii) suspected but not identified remaining disease, (iii) known residual or recurrent disease (remnant ablation, adjuvant treatment, or treatment of known disease). For DTC, the most common tools used to assess post-therapy status include serum thyroglobulin (Tg) measurement, neck ultrasonography (US), and diagnostic 131I scanning
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Abstract (DxWBS). Other imaging (CT, MRI, SPECT–CT and PET–CT) can add incremental benefit. The stimulated serum thyroglobulin (sTg) at the first 131I ablation is a good early predictor for long-term prognosis, and the sTg detected at follow-up DxWBS has an excellent negative predictive value of 98.2% when sTg is <0.5 ug/L and 95.1% when sTg is <2ug/L in our series. The DxWBS has a low yield but can be helpful for selected patients to localize the disease, although non-visualized lesion on low-activity DxWBS may be disclosed on post-treatment scans (RxWBS) with high 131I activity. A decreased RAI uptake in follow-up scan should be interpreted carefully to exclude the possibility of functional tumor dedifferentiation. FDG PET–CT is useful for the detection of neoplastic foci in patients with high-risk DTC and in those with detectable serum levels of Tg that increases over time during follow-up. Integration of RAI and FDG PET imaging results can provide valuable insights in risk stratification. Approximately 30% of patients with thyroid cancer with metastases do not demonstrate any RAI uptake. This percentage increases to 70% when a BRAFV600E mutation is present. BRAFV600E accounts for 60% of the mutually exclusive mutations of genes encoding the MAPK (mitogen-activated protein kinase) pathway, resulting in suppression of genes required for iodine uptake, organification, and retention. In RxWBS, early washout is not infrequently observed in metastatic lesions. A multidisciplinary team management of patients with RAI-refractory DTC is mandatory. Active surveillance and watchful waiting with TSH suppression can be employed in patients with asymptomatic low tumor burden. When the individual distant metastases are symptomatic or at high risk of local complications, local treatment modalities (surgery, stereotactic EBRT, ablative laser, trans-arterial embolization, radiofrequency thermal ablation) should be used prior to initiation of systemic treatment. Molecular-targeted therapy should be considered in patients with rapidly progressive, symptomatic, and/or imminently threatening disease not amenable to local control. Adverse effects of tyrosine kinase inhibitors have a great impact on quality of life, and the drug response is not durable once patients stop taking the medications. Recently BRAF, NTRK and MEK inhibitors have shown initial promising results in promoting iodine uptake in previously refractory disease. These findings have significant potential in future care of DTC patients.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PL-2
OBESITY PHARMACOTHERAPY – WHICH TREATMENTS REALLY WORK? JOHN WILDING University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, U.K.
Obesity pharmacotherapy has had a difficult history, with many challenges and some effective medicines withdrawn due to concerns over safety. More recently, better understanding of the biological mechanisms underlying body weight regulation have led to the development of more effective treatments, some of which are now entering clinical use. These include treatments targeted for the management of single gene disorders such as metreleptin for the rare condition of leptin deficiency, and setmelanotide for pro-opiomelanocortin (POMC) deficiency and some melanocortin 4 receptor mutations. For the majority of individuals with obesity a range of treatments can be considered. These include older medications such as phentermine and orlistat, which have modest efficacy and where potential adverse events have limited widespread use. Combination therapies such as phentermine / topiramate (only available in the USA) and naltrexone/bupropion have also been approved. One of the most promising areas for research has been to target hormones from the GI tract that have physiological roles in satiety, such as glucagon like peptide 1 (GLP1), peptide YY and amylin; the only approved treatment in this class is liraglutide 3mg, given sc daily. This results in effective weight loss and has been found to improve glucose control in diabetes and reduce the risk of progression to diabetes in people with impaired glucose regulation. Adverse events of nausea tend to resolve over time with gradual dose titration. More recently we have seen the results of studies with the weekly GLP1 RA semaglutide that results in weight loss of 15% or more. In the future we may see even greater weight loss, as GLP1 RAs are combined with other gut hormones, perhaps sufficient to rival the effects of bariatric surgery.
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Abstract PL-3
WHAT I HAVE LEARNED FROM PRIMARY ALDOSTERONISM THESE YEARS?
過去三十年我從原發性醛酮增多症學到的事 JEFF S. CHUEH, MD, PHD. 闕士傑 Chairman, Department of Urology, College of Medicine, National Taiwan (NTU) University, and Director, Urological Department, NTU Hospitals 台大醫學院 泌尿科 台大醫院 泌尿部
It’s an amazing journey to get into the field of primary aldosteronism (PA) for the last 30 years. My learning into this fascinating disease has never stopped from day 1, and it is still ongoing now. I am blessed to have mentors and a team of diligent colleagues working collegially together; contributing to our presence in the literature along the course of the exciting endeavor. I will categorize the things I have learned into 3 parts: 1. Surgical perspective: Laparoscopic adrenalectomy is now a treatment of choice for PA patients with unilateral disease (uPA). Thirty some years ago, open adrenalectomy was a standard; it could be done from a supine transperitoneal approach, or trans-retroperitoneal approach via a flank position or a prone jack-knife position—neither of these is easy for the patients or the surgeons, because either way the adrenal gland/tumor is so deeply situated. It was not until 1992 when Gagnier et al. published the laparoscopic approach which has revolutionized the whole chapter in the textbook. We further pioneered our modification of successful laparoscopic adrenalectomy with needlescopic instruments (< 3 mm) in more than 150 uPA patients; confirming its safety, feasibility, and benefit; bringing it more towards an ideal natural orifice surgery. 2. Diagnostic perspective: Increased plasma aldosterone concentration/plasma renin activity (ARR; PAC/PRA) is a screening test and stigmata of PA. Initially, a visible tumor in one side of the adrenal, along with an elevated ARR and positive saline loading test or captopril test was considered to be an aldosterone-producing adenoma (APA). Then, adrenal vein sampling (AVS) prevails via showing that adrenalectomy in PA patients on the
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
adrenal with no easily visible tumor or even the other side of a visible adrenal adenoma, but with strong lateralization on AVS, cured the hypertension. However, the knowledge of immunohistochemistry (IHC) staining specifically for aldosterone-synthase (CYP11B2) and steroid 11β-hydroxylase (CYP11B1), and thus aldosterone-producing cell clusters (APCC, or now called as mAPM or mAPN [multiple aldosterone-producing micronodules or multiple aldosterone-producing nodules] were identified, and the finding that ~ 30% of PA could have accompanying autonomous cortisol secretion (ACS; subclinical Cushing) has made the results of AVS not always accountable. 1mg dexamethasone suppression test thus should be a mandatary during the diagnosis of PA. NP59-SPECT scanning has important diagnostic value in lateralization by our team, but not fully supported in the literature due to lack of such isotope allowed in many western countries. The HISTOALDO pathological classification of the uPA patients helps set a communicable platform; unfortunately, hardly any pathological diagnosis in Taiwan medical centers is routinely providing the IHC diagnosis for resected adrenal tumors. A fine and accurate PA diagnosis is still out there and the endocrine pathologists in Taiwan need a tough push. 3. Beyond the diagnosis and management: There have been so many things going on with PA besides the diagnosis and management. Somatic or germ-line mutations in the functioning adrenal adenomas have opened a whole new chapter for PA, especially uPA, in which the specimens are available. From the Sanger’s PCR to the up-to-date microdissection and NGS have reveled many novel mutations than it could be imagined. Mechanism investigation with functional patch-clamp have disclosed functional versus nonfunctional mutations. Glucocorticoid-remediable Aldosteronism (GRA; FH-1) was once considered controllable with oral steroid, but we have proved that GRA patients with clear lateralization during diagnosis could have their hypertension completely cured via ipsilateral adrenalectomy; hence we recommend that lateralization test is still necessary in GRA patients. The digging just keeps going. Besides being a completely curable (no medications after surgery with a normal blood pressure) secondary hypertension in about 50% of delicately diagnosed uPA patients (out team has the best hypertension cure rate in the world), uPA has been closely associated with higher incidence of mortality and many co-morbidities than we could ever imagine— cardiovascular (MACE, LVH, CHF, atrial fibrillation, vascular stiffness), DM, bony fracture, and stroke. Many of these findings were published by our team with the use of NHRI data and further confirmed our own TAIPAI database. Moreover, with our own TAIPAI data we have 40
Abstract firmly shown that timely adrenalectomy of the uPA patients mitigated the mortality and CV morbidities, irrespective of hypertension cure or not—a finding that we did not expect until our solid statistical confirmation revealed so. We have been working on many new frontiers of PA—AI prediction of successful blood pressure control after unilateral adrenalectomy or/and the existence of genomic mutation(s) for uPA patients with pre-operative demographic or lab data, like trans-tubular potassium gradient or urine sodium/potassium ratio, and many other parameters; the associations of uPA with miR203, ACE2, or FGF-23, etc.. After 30 more years, my learning regarding PA is still ongoing, and there is no sign of stopping…
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PL-4
NON-ALCOHOLIC FATTY LIVER DISEASE AND HEPATOKINES - AN ENDOCRINOLOGIST PERSPECTIVE
非酒精性脂肪肝和肝臟細胞激素 - 內分泌學的觀點 HORNG-YIH OU 歐弘毅 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng-Kung University Hospital,Tainan, Taiwan 成大醫院內科部內分泌新陳代謝科
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common conditions with a rising burden which are present in up to approximately 70% of individuals who are overweight. NAFLD is also associated with hypertriglyceridaemia and low levels of HDL, glucose intolerance, insulin resistance and type 2 diabetes mellitus. Hepatic steatosis is a strong predictor of the development of insulin resistance and often precedes the onset of other known mediators of insulin resistance. This sequence of events suggests that hepatic steatosis has a causal role in the development of insulin resistance in other tissues, such as skeletal muscle. Hepatokines are proteins that are secreted by hepatocytes, and many of them have been linked to the induction of metabolic dysfunction, including fetuin A, hepassocin, Fibroblast growth factor (FGF21), retinol-binding protein 4 (RBP4) and selenoprotein P. Mounting evidence has revealed that the secretory profiles of hepatokines are significantly altered in non-alcoholic fatty liver disease (NAFLD) which frequently precedes other metabolic disorders, including insulin resistance and type 2 diabetes In this talk, I will describe key hepatokines and their molecular mechanisms of metabolic control in non-hepatic tissues, discussing their potential as novel biomarkers and therapeutic targets in the treatment of metabolic diseases, and take a deeper insight into recent advances in current understanding of how steatosis alters hepatokine secretion to influence metabolic phenotypes through inter-organ communication.
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Abstract MTP-E
RECENT ADVANCES AND UNMET NEED OF NUCLEAR MEDICINE IMAGING AND THERAPY IN ENDOCRINOLOGY
核醫影像與治療在內分泌系統的新進展與待克服的困難 RUOH-FANG YEN 顏若芳 Department Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan 臺大醫院 核子醫學部
Since the application of radioactive iodine in therapy of Graves’ disease was introduced in 1940, nuclear medicine has been one of the diagnostic and therapeutic modalities for endocrinological disease. There are several advances include new radiopharmaceuticals, PET scan, and hybrid scanners. There are also controversial issues, such as: quantitative dosimetry method for radionuclide therapy needed? The maximal accumulation dose of I-131 therapy? The adverse effect of radionuclide therapy? Appropriate use of PET imaging? … etc. The diagnosis and treatment of thyroid, parathyroid, and adrenal glands, will be discussed, including recent emerging nuclear medicine theranostics for neuroendocrine cancer (NET).
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
MTP-D
REVIEW AND UPDATE FOR THE DIAGNOSIS AND MANAGEMENT OF HYPERGLYCEMIA IN PREGNANCY
妊娠期糖尿病的診斷與治療 HUNG-YUAN LI 李弘元 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 臺大醫院 代謝內分泌科
Hyperglycemia in pregnancy (HIP) is an important health threat to pregnant women and their offspring. HIP results in a higher risk of developing adverse pregnancy outcomes in both the pregnant woman and the fetus. HIP includes pre-existing diabetes (PDM) and gestational diabetes mellitus (GDM). Pregnant women with GDM have higher risk of developing type 2 diabetes after delivery; whereas offspring born by women with HIP are tend to be more obese and have abnormal glucose metabolism. The terminology, diagnosis and treatment of HIP have been evolving over time in the past few years. In this meet-the-professor session, I will review the epidemiology, classification and terminology of HIP, the pathogenesis of GDM, the evolution of different diagnostic criteria of GDM, and the treatment goal and the management of HIP. In addition, the updated information from clinical recommendations of the American Diabetes Association will be discussed.
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Abstract DAROC-TADE-1
察覺糖尿病患發生嚴重低血糖症背後潛藏的警訊 FENG-CHIH SHEN 沈峰志 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 高雄長庚醫院內分泌暨新陳代謝科
糖尿病是一個緩慢無聲進行的疾病，會合併著其他共病，也會造成大血管以及小血 管的併發症。如何減少低血糖的發生是治療團隊在訂定治療策略中必須去注意的。低血 糖在流行病學的研究中發現嚴重低血糖的發生與年齡、罹病時間長短、慢性腎病變、血 脂異常有關。另外嚴重低血糖的發生會造成後續的心血管事件、癌症以及死亡。除此之 外，憂鬱、健康狀況、缺乏身心社會的支持、營養狀態、虛弱以及治療的依從性也跟嚴 重低血糖的發生以及後續不好的預後有關。因此嚴重低血糖的發生是易受傷害的表現， 臨床照護者需要更完整評估病人臨床的狀態尤其是慢性腎病變、癌症以及身心的狀態。
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
DAROC-TADE-2
“HYPOGLYCEMIA UNAWARENESS” CRISIS OR OPPORTUNITY? EFFECTIVE STRATEGY TO PREVENT AND MANAGE IT
「低血糖不自覺」是危機還是轉機 ? 預防及處置的有效策略 HAO-CHANG HUNG 洪晧彰 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 高雄榮民總醫院 內科部 內分泌新陳代謝科
Hypoglycemia has traditionally been defined by blood glucose levels of <70 mg/dL, as these levels trigger the normal physiology of counterregulatory responses to hypoglycemia. Hypoglycemia unawareness (HU), or impaired awareness of hypoglycemia (IAH), is a condition in which patients have diminished or lost ability to perceive the onset of hypoglycemia. Patients with HU develop unrecognized hypoglycemic events and thereby can often miss the opportunity to treat their hypoglycemia in a timely manner. Indeed, HU is associated with increased risk of developing severe hypoglycemia. However, the mechanisms for the development of HU remain to be elucidated. Clinically, because of the risk of developing severe hypoglycemia, patients and healthcare providers are often reluctant to advocate tight glucose control to achieve proposed glycemic targets. A major cause of HU is recurrent episodes of hypoglycemia, it is logical that a reduction in the incidence of hypoglycemia would be expected to improve hypoglycemia awareness. Studies have shown that strict hypoglycemia avoidance with rigorous monitoring and behavioral modifications can help improve hypoglycemia awareness. Additionally, blood glucose awareness training, education to optimize insulin dosing and hypoglycemia avoidance motivational programs have also been shown to improve hypoglycemia awareness. New technologies for insulin delivery and CGM can reduce severe hypoglycemia. To determine whether these new technologies could improve HU, more studies are needed.
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Abstract DAROC-TADE-3
USE CONTINUOUS GLUCOSE MONITORING WISELY TO DETECT AND PREDICT HYPOGLYCEMIA
如何聰明使用連續血糖監測來偵知並預測低血糖？ YE-FONG DU 杜業豐 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan 國立成大醫學院附設醫院 內分泌新陳代謝科
Severe hypoglycemia is associated with higher risk of cardiovascular events and mortality. Preventing hypoglycemia is an important task in reaching optimal time of blood glucose within target ranges. When severe or frequent hypoglycemia is identified, it is time to review and modify treatment regimens. Blood glucose monitoring (BGM) and continuous glucose monitoring (CGM) when applied wisely, could be usual to guide medical therapy and prevent hypoglycemia. Real-time CGM (rtCGM) which use trend of blood glucose could predict the occurrence of hypoglycemia event up to 60 minutes earlier. Patient will receive alert from CGM receiver, smartphone or smart watch and be prepared to manage hypoglycemia. As shown from IMPACT trial, patients may also modify their behavior to minimize time in hypoglycemia without the assistance of hypoglycemia predicting alert by using intermittent scanned CGM (isCGM). Before the universal use of rtCGM and isCGM, we analyzed professional CGM to identify the cause of hypoglycemia. Overdose of long acting insulin, and erroneous judgement in adjusting dose of long-acting insulin and short-acting insulin are frequently encountered problem. Educating the pharmacokinetics of the oral anti-diabetic drugs and insulin, may empower the patients to adjust insulin in correct way to avoid frequent hypoglycemia.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
DAROC-TADE-4
THE PSYCHOSOCIAL IMPACT OF HYPOGLYCEMIA AND COPING STRATEGIES AMONG PEOPLE WITH DIABETES
低血糖的社會心理影響與對策 MEI CHANG 張媚 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan 國立台灣大學醫學院護理學系
People with diabetes need to achieve a target HbA1c level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycemic events. Hypoglycemia is a common adverse event for people with type 1 and type 2 diabetes mellitus. Hypoglycemia is not only a ‘safety’ issue and an unwanted side-effect of specific treatment regimens, it also has considerable psychological impact on those affected individuals. Studies indicate that severe hypoglycemia was associated with increased fear of hypoglycemia and decreased emotional well-being, health status and diabetes-specific quality of life. Non-severe hypoglycemic events cause worry and fear in affected individuals with diabetes and may also impair their ability to perform everyday activities at home and in the workplace. The fear of future hypoglycemic episodes influences how patients manage their disease and their medication. Hypoglycemic events are a great burden for people with diabetes, as well as their families and society. Parents of children with Type 1 Diabetes mellitus experience fear of hypoglycemia, especially during times of high vulnerability. Fear of hypoglycemia could potentially impact their quality of life due to parental/child sleep disruption. Moreover, parents may be reluctant to administer suggested insulin dose because of fear of hypoglycemia. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask individuals how hypoglycemia affects important areas of their lives to better understand the personal impact, then facilitate access to tools and develop tailored hypoglycemia management plans accordingly..
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Abstract SE1-1
THE PATHOPHYSIOLOGY OF THYROID EYE DISEASE
甲狀腺眼病變之基礎病理生理學 HSUAN-WEN CHOU 周宣彣 Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan 成功大學醫學院附設醫院 內科
Thyroid eye disease is an autoimmune inflammatory disorder involving the orbit. The majority of the patients with thyroid eye disease have Graves’ disease and most of them are hyperthyroid, whereas 5% to 10% of thyroid eye disease patients are euthyroid or hypothyroid. The clinical features of thyroid eye disease include periorbital edema, eyelid retraction, proptosis, strabismus, exposure keratopathy, and compressive neuropathy. In newly diagnosed Graves’ disease, 13% will develop thyroid eye disease (mild in 10% and moderate to severe in 3%) during subsequent ATD therapy). In a few patients, thyroid eye disease onset is before that of Graves hyperthyroidism. Currently, the exact pathogenesis of thyroid eye disease appears to involve complex molecular and cellular processes that have not be understood completely yet. However, understanding the pathogenesis of thyroid eye disease might be the potential for effective treatment and prevention options.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE1-2
THYROID EYE DISEASE: PERSPECTIVES FROM AN OPHTHALMOLOGIST'S POINT OF VIEW
甲狀腺眼疾：眼科醫師之觀點 YI-HSUAN WEI 魏以宣 Department of Ophthalmology, National Taiwan University Hospital,Taipei, Taiwan 臺大醫院 眼科部
Thyroid eye disease or Graves’ ophthalmopathy (GO) is the most common extra-thyroid manifestation of Graves’ disease. The ocular manifestations represent orbital inflammation, tissue expansion, and fibrosis that often lead to substantial morbidity. The clinical signs of GO may comprise any of the following: conjunctival chemosis, periorbital soft tissue swelling, proptosis, eyelid retraction, restriction of eye movement, and decrease of vision due to exposure keratopathy or compressive optic neuropathy. The exact pathogenesis of GO has yet to be understood, and the disease remains a therapeutic challenge. Treatment strategies vary depending on disease severity and activity. In this talk, we will introduce the clinical course of GO as well as the treatment for different stages of disease. We will focus on the surgical management of GO, including orbital decompression, strabismus correction, and eyelid repositioning. Moreover, how to recognize the problematic GO patient is very important to prevent them from irreversible visual impairment. Some complicated or intractable cases will be discussed in this talk. Endocrinologists and ophthalmologists offer distinct contributions to the care of patients with GO. We believe that the best outcomes come from good coordination between the two specialists.
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Abstract SE1-3
REVIEW OF 2021 EUGOGO CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF GRAVES’ ORBITOPATHY
甲狀腺眼疾之 2021 年 EUGOGO 治療指引回顧 KUAN-HUA CHEN 陳冠樺 Department of Endocrinology and Metabolism , E-Da Hospital , Kaohsiung City, Taiwan 義大醫院 新陳代謝科
Graves’ orbitopathy is a major extrathyroidal manifestation of Graves’ disease. Early identification and referral to specialized centers is fundamental for treatment. Clinical therapy should be individualized based on the severity and activity of the disease. Removal of risk factors is crucial for most patients, which includes smoking, thyroid dysfunction, high serum level of thyrotropin receptor antibodies, radioactive iodine treatment, and hypercholesterolemia. In management of patients with mild and active Graves’ disease, local treatment and selenium (especially in selenium deficient areas) are usually sufficient. As for moderateto-severe patients, first line therapy should consist of steroid treatment with or without mycophenolate on a weekly basis. If the patient responded poorly, 2nd line treatment is then considered, including high-dose of prednisolone, immunosuppressants, orbital radiotherapy, and novel agents such as Teprotumumab, Rituximab, and Tocilizumab. Last but not least, sight-threatening orbitopathy should be treated with daily intravenous methylprednisolone on three consecutive days, while orbital decompression surgery should be considered based on patients’ response.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE2-1
ENDOCRINOLOGY AND AGING
內分泌系統與老化 CHIH-YAO HSU 許智堯 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan 新竹臺大分院 內科部代謝內分泌科
As the population of Taiwan is rapidly aging, common health conditions of the elderly have become a socioeconomic issue. Many factors influence healthy aging. All physiologic functions begin to decline gradually throughout adult life. Part of the aging process includes loss of muscle strength, decrease in bone mineral density, and increase in fat mass. These alterations in body composition might be related to changes in the endocrine system. Hormone levels decrease with age, and the two most important clinical changes in endocrine activity during aging include the pancreas and the thyroid gland. In addition to reduced insulin secretion, peripheral insulin resistance related to unhealthy diet and physical inactivity results in the deterioration of glucose metabolism. Age-related thyroid dysfunction is also not unusual. The adverse effects of overt thyroid dysfunction in the elderly are well understood. However, the clinical significance of mild hypothyroidism and hyperthyroidism remains controversial. Menopausal transition is a normal part of aging for women. Menopause is diagnosed 12 months after a woman's last period. Hormone therapy quickly alleviates the symptoms of menopause, such as hot flushes, vasomotor instability, and symptoms of urogenital atrophy. However, the Women’s Health Initiative (WHI) trial was discontinued early because of an increase in cardiovascular complications and increased incidence of breast cancer in the estrogen-progestin treatment group. Reassessment of the data from the WHI and other studies implies that the benefits of hormone therapy appear to outweigh its risks for most symptomatic women who are either under age 60 years or less than 10 years from menopause. Age-related hypogonadism does not progress as clearly in men as in women at menopause. The Endocrine Society Clinical Practice Guideline recommends not 52
Abstract treating asymptomatic older men with age-related decline in testosterone levels. Dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are inactive precursors that are transformed within human tissues into androgens or estrogens. There is no convincing evidence to recommend the routine use of DHEA for anti-aging at present. During the aging process, growth hormone (GH) secretion declines. GH administration in older adults increases lean body mass and decreases fat mass, but GH treatment does not improve muscle strength and functional capacity in the elderly.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE2-2
ANTI-AGING IN TRADITIONAL CHINESE MEDICINE
中醫觀點看抗老化 WEI-JEN CHENG 鄭為仁 Center for traditional Chinese medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan 長庚紀念醫院中醫部
Aging is a natural phenomenon, an intrinsic feature of life. The possibility to manipulate aging has fascinated people and filled imagination throughout the history of humankind. Nowadays, researchers worldwide are intended to clarify the secret of aging in the human body. Traditional Chinese medicine (TCM) is an ethnomedicine derived from philosophy and culture in ancient China. During the development of TCM for thousands of years, many treasures have been found with lots of medical usage. Huangdi Neijing (traditional Chinese: 黃帝內經 ), an ancient Chinese medical text, has been thought of the fundamental doctrinal source of TCM. The health care and organ systems balance in the human body for longevity was first described in the text. Studies in TCM materials revealed anti-inflammation, reducing oxidative stress, promoting wound healing, regulating hormones and metabolism, which were considered to involve the important processes in human aging. Recent evidence has also shown a picture that low caloric intake, fasting, and exercise might improve the health condition and senescence, which were believed to be the essential behavior for longevity in ancient China. In this session, we will discuss the possibility of TCM in anti-aging based on TCM theory and recent evidence.
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Abstract SE2-3
SKELETAL MUSCLE AS THE ENDOCRINE ORGAN FOR AGING
骨骼肌作為老化的內分泌器官 LIANG-KUNG CHEN 陳亮恭 Superintendent, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital, Taipei, Taiwan) Distinguished Professor, Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan 臺北市立關渡醫院（北榮經營） 院長 國立陽明交通大學健康長壽與老化科學研究中心 特聘教授
Aging is a complex process involving multiple bio-psycho-social factor and the World Health Organization proposed “Healthy Aging” to develop and maintain functional ability in the life course to ensure late-life well-being of any individual. In the clinical practice, healthy aging aims to prevent disability and dementia in the late life through multi-domain intervention. Despite that multiple organ systems are involved in the aging process, the roles of skeletal muscle have been highlighted in recent years. Sarcopenia is defined as the age-related loss of muscle loss plus reduced muscle strength or/and physical performance. The Asian Working Group for Sarcopenia has published sarcopenia diagnostic criteria for Asian population and supported various intervention studies. Currently, sarcopenia can be managed by exercise (aerobic + resistance) with nutritional support. On the other hand, pharmaceuticals for sarcopenia are still under development that some trails failed at 2/3 phases because simply increasing skeletal muscle mass does not improve muscle strength. Moreover, skeletal muscle has been recognized to play endocrine function to crosstalk with other organs, including neurons. Atrophic muscle fibers secrete miR-29b-3p via exosomes to trigger neuron senescence that links muscle-brain axis in the aging process. Further investigations are needed to confirm the roles of skeletal muscle in mediating aging and to develop appropriate neutraceuticals and pharmaceuticals for healthy aging.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE3-1
CLINICAL PRESENTATION AND MANAGEMENT OF HYPOPHYSITIS
腦下垂體炎的臨床表現及治療 KUAN-YU LIN 林冠宇 Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch,Yun-Lin, Taipei 台大醫院雲林分院 內分泌新陳代謝科
Hypophysitis is a rare condition when inflammation of the pituitary gland, infundibulum, or both takes place. Primary hypophysitis includes lymphocytic hypophysitis (the most common), IgG4-related hypophysitis (recently recognized), granulomatous hypophysitis, and much rarely xanthomatous hypophysitis or necrotising hypophysitis. Secondary hypophysitis includes drugs related, especially immune-checkpoint inhibitors (ICIs), and other systemic diseases involving pituitary glands like granulomatous, neoplastic, infectious, vascular and autoimmune disorders. Clinical manifestations of hypophysitis depend on whether compressive symptoms present, and which pituitary hormones are involved. Headache is the most common symptom, and visual field defect or cranial nerve palsies sometimes occur. Different causes of hypophysitis have different predilections of specific pituitary hormone deficiencies, but there are no hallmark symptoms typical of any type of hypophysitis. Diabetes insipidus will be present if the posterior lobe is involved. Subtypes of hypophysitis may be difficult to clarify without biopsy due to a broad differential diagnosis and hormonal/radiological features overlap. History is important when approaching patients with symptoms of hypophysitis. Recent pregnancy or ICIs use provides strong clinical clues to the diagnosis. Detailed physical examination and review of symptoms are required to rule out systemic inflammatory disorders. Specific diagnostic criteria for IgG4-related hypophysitis have been proposed. Complete pituitary hormone panels should be obtained, as undiagnosed adrenal insufficiency may lead to potential lethal consequences. Antipituitary antibodies had been proposed in previous studies, but the diagnostic accuracy is in question. Anti-Pit 1 antibody syndrome presents as acquired deficiencies of growth 56
Abstract hormone, TSH and prolactin. Recently HLA-DQ8 and DR53 were found to be associated with increased risk of lymphocytic hypophysitis. The pituitary MRI image of hypophysitis is characterized by an intense and homogeneously enhanced gland with a thickened but not deviated stalk. A radiological score has been proposed to differentiate hypophysitis from pituitary adenoma. Treatment of hypophysitis in the acute phase includes active surveillance, hormone replacement, anti-inflammatory therapies, surgery and radiotherapy. Surgery is indicated if there’s significant mass effect or progressive visual deterioration despite medical treatment, or when histological diagnosis is warranted to exclude the diagnosis of tumor. In lymphocytic hypophysitis, glucocorticoid resulted in good responses initially, but the recurrence rate is high, and long-term steroids use may cause undesirable side effects. Steroids are also the mainstay treatment in IgG4 related hypophysitis and grade 3-4 ICI-induced hypophysitis. Other proposed steroid-sparing therapies include azathioprine, methotrexate, mycophenolate and monoclonal CD-20 antibody rituximab. Radiotherapy may also be considered in progressive or recurrent hypophysitis. Dopamine agonists could be used in patients with symptomatic hyperprolactinemia. In chronic phases of hypophysitis when fibrosis and pituitary atrophy occur, long-term replacement of hormone deficiencies is required.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE3-2
TRAUMATIC BRAIN INJURY-ASSOCIATED HYPOPITUITARISM
頭部外傷與腦下垂體功能低下 I-CHIEH MAO 毛羿傑 Department of Intensive Care Medicine, Changhua Christian Hospital, Changhua County, Taiwan Department of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua County, Taiwan 彰化基督教醫院 重症醫學科、彰化基督教醫院 內分泌新陳代謝科
Since one century ago, traumatic brain injury (TBI) was considered a rare cause of hypopituitarism. However, recent studies suggested that TBI-mediated hypopituitarism was more frequent than previously though. The prevalence was inconclusive because of different trauma severity and timing of pituitary hormone evaluation. Exact mechanism underlying TBI-mediated hypopituitarism has not yet been clearly elucidated and is likely the result of a combination of several process. Since testing all patients with TBI is not clinical cost-effective, the most important challenge is to determine who should be screened. Clinical guideline also includes screening strategy after discharge from hospital. Many unanswered questions are needed to be investigated regarding the true face of TBImediated hypopituitarism.
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Abstract SE3-3
CARDIOVASCULAR HEALTH IN PATIENTS WITH PITUITARY TUMORS
腦下腺腫瘤患者的心血管健康 JUN-SING WANG 王俊興 Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan 台中榮民總醫院 內分泌新陳代謝科
Patients with pituitary tumors of various etiologies had an increase in risk of allcause mortality. Patients with functional pituitary tumors may have multiple risk factors of cardiovascular diseases which may contribute to their higher risk of mortality. Nevertheless, patients with non-functional pituitary tumors may also have a higher risk of all-cause and cardiovascular mortality compared to the general population. Patients with non-functional pituitary tumors may undergo surgical intervention for the tumors, after which hormone replacement may be required. The treatment may be associated with some cardiovascular risk factors which may explain the higher risk of mortality in this population. Nevertheless, even in those who do not require hormone replacement after surgical intervention for non-functional pituitary tumors, the risk of mortality remains high in previous reports. In this talk, I will have a brief review on this topic.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE4-1
DO COVID VACCINES AFFECT MENSTRUATION?
COVID 疫苗對月經週期的影響 - 個案分享 SZU-HAN LIN 林思涵 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yunlin Christian Hospital, Xiluo Township, Yunlin County, Taiwan 雲林基督教醫院 內分泌暨新陳代謝科
Common side effects of coronavirus disease 2019 (COVID-19) vaccines include fever, fatigue, myalgia, and headache. However, menstrual disturbance including changes of volume and menstrual cycle are not listed. Recent study investigates the relationship between COVID-19 vaccination and menstrual cycle disturbances. Some women with regular menstrual cycle may have menstrual disturbance post vaccination. However, breakthrough bleeding is uncommon in the amenorrhea patient. Both mRNA and adenovirus vector COVID-19 vaccines are reported with menstrual change, suggesting that it may be subsequent immune response rather than specific component of vaccines. Researches exploring the association and possible mechanisms of vaccineinduced menstrual abnormalities are ongoing. The assumed mechanism of immune response includes acute immune attack, systemic effects on hemostasis and inflammation, and menstrual repair mechanism. This time, we present a 49-year-old woman with history of panhypopituitarism and secondary amenorrhea for more than 19 years who having vaginal bleeding and dysmenorrhea after administration of COVID-19 vaccine.
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Abstract SE4-2
NEW ONSET OF GRAVES’ DISEASE WITH THYROID STORM AFTER ADENOVIRUS-VECTORED COVID-19 VACCINE
施打新冠肺炎疫苗後新診斷的葛瑞夫茲氏病併甲狀腺風暴 HOK WENG LO 羅學榮 Division of Endocrinology & Metabolism, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan 國泰綜合醫院 內分泌新陳代謝科
A few cases of Graves’ disease after inactivated or mRNA vaccine had been reported. However, new onset of Graves’ disease with thyroid storm after adenovirus-vectored vaccination had not been reported in the literature. We described a case of newly onset of Graves’s disease with thyroid storm after adenovirus-vectored COVID-19 vaccination (Vaxzevria) 6 days later. Thyroid storm was diagnosed based on thyrotoxicosis and clinical manifestations. Positive anti-TSH-receptor-Ab, higher titer of thyroid-stimulating immunoglobulin and thyroid ultrasound competitive with the diagnosis of Graves’ disease. How adenovirus-vectored COVID-19 vaccine can induce Graves’ disease remained unanswered. The excipient with polysorbate 80 of adenovirus-vectored COVID-19 vaccine may act as the adjuvant which induced Graves’ disease on top of our patient’s genetic background of hyperthyroidism. To our knowledge, this is the first case of Graves’ disease with thyroid storm secondary to adenovirus-vectored COVID-19 vaccine.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE4-3
COVID-19 AND ADRENAL INSUFFICIENCY
嚴重特殊傳染性肺炎（COVID-19）與腎上腺機能不全 CHEN-YU WEN 溫振宇 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 國立臺灣大學醫學院附設醫院 內科部
Coronavirus disease 2019 (COVID-19) is now considered as a multiorgan disease with various clinical manifestations. Recent studies found that multiple endocrine systems, including hypothalamus-pituitary-adrenal axis, were affected by COVID-19 during the disease course. Hypocortisolism was firstly reported in patients with SARS, and the causative virus, SARSCoV-1, was also identified in adrenal glands in ceased individuals. A more recent study showed that angiotensin-converting enzyme 2 (ACE2) receptor and transmembrane serine protease 2 (TMPRSS2), both required for SARS-CoV-2 obtaining entrance into cells, are widely expressed in adrenal glands. Two major hypotheses proposed to explain the association between SARSCoV-2 infection and adrenal gland include direct damage on adrenocortical cells and an induced state of “molecular mimicry” against adrenocorticotrophic hormone (ACTH). Several cohort studies of patients with COVID-19 showed higher plasma cortisol level compared with those without COVID-19. Moreover, one study showed that the prevalence of critical illness-related corticosteroid insufficiency (CIRCI) is also relatively low in COVID-19 patients compared with non-COVID-19 ones. By contrast, other studies demonstrated the opposite results, which showed adrenal insufficiency and CIRCI are not uncommon in patients with COVID-19. These conflicting data and various sample size make the exact relationship between COVID-19 and adrenal gland still inconclusive. Dexamethasone, a synthetic glucocorticoid suppressing the hypothalamus-pituitaryadrenal axis, was shown to reduce 28-day mortality in COVID-19 patients requiring oxygen therapy. In a cohort study of survivors of COVID-19, for those receiving dexamethasone, none of them had evidence of adrenal insufficiency after 3 months. Moreover, all patient in this study, regardless of whether receiving dexamethasone or not, had adequate adrenal reserve at 3 months after presentation with COVID-19. 62
Abstract SE5-1
HYPERPARATHYROIDISM-DIFFERENTIAL
副甲狀腺機能亢進鑑別診斷 YAN-RONG LI 李晏榮 Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taiwan, ROC 林口長庚紀念醫院 內分泌暨新陳代謝科
The finding of the elevated serum calcium concentration is usually the first clue of hyperparathyroidism and when hypercalcemia is confirmed by repeat sampling, all of causes should be considered. A29-year-old man presented to the emergency department with urinary incontinence that began suddenly five days earlier. He had weakness in both legs (muscle power decreased to 4/5) with numbness. Upon investigation, the patient had hypercalcemia (serum calcium 3.485 [normal range 1.975–2.475] mmol/L) and hypophosphatemia (serum phosphate 0.581 [normal range 0.775– 1.518] mmol/L) with an elevated level of intact parathyroid hormone (1956 [normal range 14–72] ng/mL). Magnetic resonance imaging of his spine showed two lesions over posterior elements of T10 and L4, with compression of the spinal cord at T10. The patient had an urgent surgical decompression of the T10 lesion, which, on histology, was composed of round to spindled mononuclear cells and numerous osteoclast-type giant cells with some bony trabeculae. What disease should be considered first?
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE5-2
HYPERPARATHYROIDISM IN MULTIPLE ENDOCRINE NEOPLASIA
MEN 及家族性副甲狀腺高能症 YE-FONG DU 杜業豐 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng-Kung University Hospital, Taiwan,Tainan, Taiwan 國立成大醫學院附設醫院 內分泌新陳代謝科
Multiple endocrine neoplasia (MEN) is a rare hereditary disease which encompasses several distinct syndromes featuring tumors of endocrine glands, with autosomal dominant inheritance. It can be classified into MEN1, MEN2A, MEN2B, and MEN4. Hyperparathyroidism (HPT) can be found in MEN1 and MEN2A, caused by MEN1 and RET gene mutation respectively. The most common presentation of MEN1 is hyperparathyroidism with penetration more than 90%. Compared with sporadic primary HPT, hyperparathyroidism in MEN1 is caused by multiple parathyroid hyperplasia, identified at younger age (20~25 years old vs. 55 years old) and is easier recurred after operation. These features should urge physician to survey the possibility of MEN and to obtain a detailed family history. Besides MEN1 and MEN2, there are also other familial hyperparathyroidism, including MEN4, hyperparathyroidism jaw-tumor syndrome (HPT-JT), neonatal severe hyperparathyroidism (NSHPT), autosomal dominant moderate hyperparathyroidism (ADMH), and familial isolated hyperparathyroidism (FIHPT). If hyperparathyroidism is caused by some familial syndrome, earlier gene diagnosis will guide us to identify potential life-threatening co-morbidities such as pheochromocytoma and pancreatic neuroendocrine tumors earlier, or proceed to life-saving prophylactic thyroidectomy in MEN2A.
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Abstract SE5-3 LITHIUM-INDUCED HYPERPARATHYROIDISM AND HYPERCALCEMIA
鋰鹽引起的副甲狀腺高能症和高鈣血症 WEI-YIH CHIU 邱偉益 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 臺大醫院內科部 代謝內分泌科
In the case of hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone concentrations. The finding of an increased serum calcium level in the presence of an inappropriately elevated PTH concentration suggests a parathyroid hormone-dependent hypercalcemic disorder. Chronic lithium therapy can rarely lead to hypercalcemia secondary to lithium-induced hyperparathyroidism. Lithium is one of the mainstays of treatment for bipolar disorder. We present a 29-year-old male patient with bipolar disorder on lithium therapy presenting with hypercalcemia. The pathophysiology and management of hyperparathyroidism and hypercalcemia in patients on chronic lithium therapy will be discussed.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE6-1 GENETICS AND BIOLOGY OF PHEOCHROMOCYTOMA AND PARAGANGLIOMA (PPGL)
嗜鉻細胞瘤與副神經節瘤之遺傳學與生物學 1,2,3
PEI-LUNG CHEN
1,2,3
陳沛隆
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, 2Department of Medical Genetics, National Taiwan University Hospital, Taiwan, R.O.C.; 3Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taiwan, R.O.C. 1
台大醫院內科部新陳代謝科、 2 台大醫院基因醫學部、 3 台灣大學基因體暨蛋白體醫學研究所
Pheochromocytoma and paraganglioma (PPGL) comprises catecholamine-secreting tumors of neural crest origin, derived from the adrenal medulla or extra-adrenal ganglia, respectively. It is a very important disease drawing high attention. Clinically, PPGL is associated with high morbidity and mortality because of mass effect and high blood circulating catecholamines. PPGL is considered malignant, with various degrees of potentials of metastasis. Furthermore, high recurrence rate in family members, but lack of a reliable prediction of affected status, makes the diseases daunting. PPGL is actually not rare, and the prevalence figures approximate 0.2% in autopsy series. Clinical manifestations can vary widely, depending on the predominant type of catecholamine secreted (epinephrine, norepinephrine, dopamine), the presence of co-secreted neuropeptides and whether secretion is sustained or episodic. A characteristic presentation is intermittent paroxysms of symptoms and signs related to episodic catecholamine release, including hypertension, headache, anxiety, sweats, pallor, flushing or palpitation. However, variable and non-specific manifestations make early diagnosis a real challenge. PPGL was once called “10% tumors”, and, before the 21st century, was believed to have ~10% of patients determined genetically. In those early days, the genes known to cause PPGL were NF1, RET, and VHL. However, thanks to the rapid advance in genetics/ genomics during the past 15 years, we now recognize many additional single autosomal dominant genes for PPGL, including SDHD, SDHC, SDHB, SDHA, SDHAF2, EPAS1, FH, HIF2A, TMEM127 and MAX. It is now clear that germline disease-causing variants can 66
Abstract explain approximately 40% of PPGL cases; the remaining 60% might be sporadic cases caused by somatic mutations. Understanding genetics and biology of PPGL will benefit clinical care and basic research of PPGL.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE6-2
PHEOCHROMOCYTOMA AND PARAGANGLIOMA (PPGL) – DIAGNOSIS AND PERI-OPERATIVE MANAGEMENT
嗜鉻細胞瘤以及副神經瘤的診斷與手術期間的處置 YI-HSUAN LIN 林怡瑄 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC 林口長庚紀念醫院 內分泌暨新陳代謝科
Pheochromocytomas (PHEOs) and paragangliomas (PGLs), which are jointly referred to as PPGLs, are catecholamine-secreting endocrine tumors that originate in the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. These tumors are rare, with an annual incidence of two to eight cases per 1 million people. PHEOs are more common, accounting for about 80–85% of PPGLs. The prevalence of PPGLs in individuals with hypertension(HTN) in general outpatient clinics is approximately 0.2–0.6%. Additionally, the incidence rate of PPGLs is between 0.04 and 0.21 per 100,000 person-years. When patients have signs and symptoms of PPGLs, especially paroxysmal HTN, HTN at a young age, resistant HTN, adrenal incidentaloma, family history or history of previous PPGLs or idiopathic dilated cardiomyopathy, or a familial syndrome that causes predisposition to catecholamine-secreting tumors, biochemical testing should be initially performed. Because the amount of secreted catecholamines fluctuates, measurements of plasma metanephrines in the supine position and 24-h urine fractionated metanephrine levels have been suggested. If the result discloses just mild elevated metanephrines level, clonidine suppression test could be a method for confirmation. If a PPGL is suspected, then an image study is necessary. The first suggested method is computed tomography (CT) with contrast if the patients are feasible. 123I-metaiodobenzylguanidine (MIBG) scintigraphy and 2-deoxy-2-[fluorine-18] fluoroD-glucose positron emission tomography integrated with CT are suggested for functional imaging for detecting metastatic PPGLs. A hormonally functional PPGL should be removed; however, some preparations are needed before surgery.
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Abstract According to current guidelines, to reduce perioperative morbidity and mortality, all patients with hormonally functional PPGLs should undergo 7–14 days of preoperative preparation, which includes a high sodium diet, fluid intake, and medical receptor blockade (α-Adrenoceptor antagonists, β-Adrenoceptor antagonists, Calcium channel blockers, α-Methyl-para-tyrosine (metyrosine) can be considered) to normalize blood pressure and to reverse blood volume contraction. The recurrence rate of PHEOs after adrenalectomy is 6.5–16.5%, and a large tumor (> 5 cm) is a risk factor for recurrence. Current guidelines suggest lifelong annual measurement of plasma or urine levels of metanephrines for recurrent or metastatic disease assessment6. However, because 25% of patients with recurrence show no abnormal biochemical findings, routine imaging is recommended. Once a metastatic or recurrent disease is confirmed, further treatments include operation, chemotherapy, MIBG or molecular targeted therapy, or immunotherapy
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE6-3
RECENT ADVAN1CE IN THE MANAGEMENT OF METASTATIC PHEOCHROMOCYTOMA AND PARAGANGLIOMA
轉移嗜鉻細胞瘤及副神經瘤治療之最新進展 LIANG-YU LIN M.D. PH.D. 林亮羽 Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan 臺北榮民總醫院內分泌新陳代謝科
Pheochromocytomas and paragangliomas (PPGLs) are rare tumors that cause refractory hypertension and hypertensive crisis. A nationwide epidemiological survey in Japan revealed that the annual number of patients with PPGL was 3000, which was higher than that reported previously. Most patients with PPGLs have localized disease and may be cured by surgery. Although metastatic disease accounts for 30% of PPGLs, the diagnosis of malignancy is difficult without the presence of metastatic lesions. To pinpoint metastatic potential in PPGLs is difficult, but nevertheless crucial for the individual patient to receive tailor-made followup and adjuvant treatment following primary surgery. A combination of histological workup and molecular predictive markers can possibly aid the clinicians in this aspect. Genetic testing is important, both for counseling and prognostic estimation. Apart from computed tomography and magnetic resonance imaging, molecular imaging using 68Ga-DOTATOC/ DOTATATE should be performed. 123I-MIBG scintigraphy may be performed to determine whether 131I-MIBG therapy is a possible option. As first-line treatment in patients with metastatic disease, 177Lu-DOTATATE or 131I-MIBG is recommended, depending on which shows best expression. In patients with very low proliferative activity, watch-andwait or primary treatment with long-acting somatostatin analogues may be considered. As second-line treatment, or first-line in patients with high proliferative rate, chemotherapy with temozolomide or cyclophosphamide + vincristine + dacarbazine is the therapy of choice. Other therapies, including sunitinib, cabozantinib, everolimus, and PD-1/PDL-1 inhibitors, have shown modest effect. Metastatic PPGLs need individualized management and should always be discussed in specialized and interdisciplinary tumor boards. 70
Abstract SE7-1 THE ROLE OF INTEGRATED IMAGING IN THE MANAGEMENT OF THYROID CANCER
綜合影像於甲狀腺癌診療之角色 YEN-HSIANG CHANG 張雁翔 Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan 高雄長庚紀念醫院 核子醫學科
Thyroid cancer is the most common endocrine cancer, accounting for approximately 3% of all cancers diagnosed each year in Taiwan. Primary thyroid cancers are classified according to their histologic subtype. The most common types of thyroid cancer are papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). Surgery is the primary mode of therapy for patients with differentiated thyroid cancer, followed by radioiodine therapy. Radioiodine is either as a means of treatment to ablate residual thyroid tissue/malignancy, or as a means of imaging to detect radioiodine-avid metastatic disease. Planar whole-body scan (WBS) is routinely performed after radioiodine treatment; however, hybrid SPECT/CT is proven to be more accurate in the evaluation of residual and metastatic disease. Thus, post-therapy WBS with SPECT/CT is strongly recommended in current guidelines. F-18 FDG PET/CT has a valuable role in the initial workup for solid tumors, such as head and neck cancer, lung cancer, etc. However, the role of F-18 FDG PET/CT for staging in thyroid cancer patients is still under debate. In the current guidelines, F-18 FDG PET/CT is considered for detecting recurrent disease in those with negative radioiodine whole body scan but elevated serum thyroglobulin. For patients with newly diagnosed thyroid cancer, F-18 FDG PET/CT is suggested for those with advanced T stage or with unfavorable pathology. F-18 FDG-PET/CT and radioiodine WBS are complementary imaging modalities and should be combined to improve detection of locoregional recurrence and distant metastases of thyroid cancer in high-risk patients. The multidisciplinary consensus interpretation is a key element for diagnostic and prognostic approaches. 71
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SE7-2 TRANSORAL ENDOSCOPIC THYROIDECTOMY FOR THYROID DISEASE
經口內視鏡甲狀腺切除手術治療甲狀腺疾病 MING-HSUN WU 吳明勳 Department Surgery, National Taiwan University Hospital, Taipei, Taiwan 台大醫院 外科
Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. There has been growing interest to the transoral endoscopic thyroidectomy vestibular approach (TOETVA) where early experience has been with an excellent safety profile and outcomes. TOETVA minimizes the need for tunneling flap dissection when compared with other extra cervical approaches (anterior chest wall, breast, or axillary approaches). However, although initially surrounded by skepticism due to technical challenges, the introduction of new complications, and concerns about oncologic safety and cost, some of them have been approached progressively more widely by the community of endocrine surgeons. Anyhow, it is strictly recommended to adhere to selection criteria. The eligibility criteria for TOETVA are the following: thyroid gland of a diameter not exceeding 10 cm, comprising either benign thyroid nodule, papillary cancer less than 2cm with no evidence of lateral neck metastasis, follicular neoplasm (?), or well-controlled Graves’ disease. In summary, TOETVA is a new technique that provides the best cosmetic results considering that is totally scarless, with a short distance between the thyroid gland and the incisions.
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Abstract SE7-3 PRECISION MEDICINE IN METASTATIC THYROID CANCER
轉移性甲狀腺癌的精準治療 FENG-CHE KUAN 官鋒澤 Department of Oncology, Chang-Gung Memorial Hospital, Chia-Yi Branch, Chia-Yi County, Taiwan 嘉義長庚醫院 腫瘤科
The incidence and mortality rate of thyroid cancers in Taiwan rank the 13th and 26th in male malignancies and rank the 4th and 22th places in female malignancies, respectively. Among thyroid malignancies in SEER database, the prognosis of anaplastic thyroid carcinoma is the least and 5-year survival rate of localized tumor is only 31%. Also, the prognosis of metastatic thyroid cancer is relatively poor, and the 5-year survival rate of papillary cancer is 76%. Although the prevalence of common mutations among thyroid malignacies were known in early 2010, the personalized medicine get revolutionized only when the multikinase inhibitor developed. In randomized phase 3 trials, cabozantinib or vandetanib and sorafenib or lenvatinib show better progression-free survival than placebo in metastatic medullary and radio-iodine refractory differentiated thyroid cancers, respectively. For multiple hits on the signaling pathway, these multikinase inhibitors have their well-known side effects, such as diarrhea, hand-foot-skin reaction, hypertension and fatigue. Newer kinase inhibitors with fewer targets also show their strength in the treatment of metastatic thyroid cancers in single arm or basket phase 1/2 trials, such as kiniase inhibitors of BRAF V600E mutations, NTRK fusion, and RET fusion or mutations. However, these fusion and mutations could be rare and the cost-effectiveness of next generation sequencing is under heated debate. How clinicians provide the our patients with the right drugs in the right time is an essential issue we keep on learning in the precision oncology era.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE8-1
THE CLINICAL UTILITY OF MOLECULAR PROFILING ON ENDOCRINE TUMORS
廣泛型癌症基因檢測於內分泌腫瘤的臨床應用 CHIEN-FENG LI 李健逢 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan 奇美醫院醫學研究部、國立中山大學精準醫學研究所、國家衛生研究院癌症研究所
Surgery is the mainstay of most early-stage endocrine tumors; chemo-/targeted therapy and experimental therapies remain the therapeutic cornerstone in unresectable and metastatic lesions. Recent studies further disclosed the biological and immune landscapes of cancers leading to the development of potential biomarkers carrying prognostic and/or therapeutic relevance. Emerging integration of molecular profiling datasets has led to the identification of distinct molecular features of special subsets of these lesions with diverse clinical behaviors and potential sensitivity to various therapies. It has also led to the disclosure of frequently altered genes and proteins that could lead to perturbation of intracellular signaling pathways. In this talk, we will briefly summarize the morphological and genomic biomarkers that may predict the nature course of and/or response to various therapeutics with examples of ‘personalized treatment’ aiming to improve outcomes in endocrine tumors with special attention to the most common forms namely gastroenteropancreatic neuroendocrine tumour (GEPNET) and papillary thyroid carcinoma (PTC).
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IN THE ERA OF THERANOSTICS – PEPTIDE RECEPTOR RADIONUCLIDE THERAPY (PRRT) IN NEUROENDOCRINE TUMORS (NETS) MEI-FANG CHENG 鄭媚方 Department of Nuclear Medicine, National Taiwan University Hospital and College of Medicine,Taipei, Taiwan 臺大醫院核子醫學部
Even though neuroendocrine tumors (NETs) are slow-growing malignancies, they can cause significant morbidity secondary to the overproduction of bioactive substances or hormones. Whereas in non-functioning NETs, diagnosis is even more difficult and patients are often present at an advanced stage of disease. More than 90% of NETs express somatostatin receptors (SSTRs), especially type 2A. 177Lu-DOTATATE, a beta-emitter, targets SSTR2A receptor, enables delivering radiation directly to the tumor sites (peptide receptor radionuclide therapy, PRRT). Pretreatment imaging using 68Ga-DOTATOC PET, a tracer that also binds to SSTR2A receptor, can be used to document tracer avid disease, therefore selecting patients for the corresponding therapy (theranostics, combining imaging and therapy).
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE8-3
TARGET THERAPY FOR NEUROENDOCRINE TUMORS
神經內分泌瘤之標靶治療 HUI-JEN TSAI 蔡慧珍 National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan 國家衛生研究院 / 癌症研究所
Neuroendocrine tumors (NETs) are heterogenous tumors with different grade and of different primary sites. The most common sites of NETs include gastroentero-pancreas (GEP) and lung. Early-stage NETs can usually be cured by surgical resection. However, advanced NETs have relatively poor survival. Many targeted therapies have been developed for the treatment of advanced NETs based on their characteristics, such as expression of somatostatin receptor, mTOR activation and hypervascularity. Somatostatin analogues (SSA), everolimus (mTOR inhibitor), and sunitinib have been shown to improve the survival of quality of life of functional or advanced GEP-NET patients by phase II/III trials in the recent decades. In addition, everolimus has also been shown to improve the survival of lung NETs by phase III clinical trial. Other target agents, such as surufatinib, lenvatinib, axitinib, pazopanib, and cabozantinib have also been shown their efficacy in advanced GEP-NETs in phase II or III clinical trials. Combinational treatment is also a treatment option. Temsirolimus, a mTOR inhibitor, and bevacizumab, an anti-VEGFA monoclonal antibody, have been shown efficacy in advanced pancreatic NETs. The efficacy of everolimus combined with SSA has also evaluated in clinical trials. Combination of target agent with chemotherapeutic agent may also be a treatment option. Exploration of other novel targeted agents or combinations is still ongoing not only to prolong the survival but also maintain the quality of life of advanced NET patients.
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INTRACARDIAC PARAGANGLIOMA
心臟副神經節瘤 TING-CHU CHEN 陳亭竹 Division of Endocrinology and Metabolism, Department of Internal Medicine, Hsin-Chu Branch of National Taiwan University Hospital, Hsin-Chu, Taiwan 國立臺灣大學醫學院附設醫院新竹臺大分院 內分泌新陳代謝科
A 44-year-old man with hypertension presented to the emergency department of National Taiwan University Hospital due to persistent upper abdominal distention and dull pain for 3 days. A computed tomography (CT) scan of the abdomen and pelvis revealed dissection at proximal superior mesenteric artery initially. Operation was suggested but the patient favored conservative treatment. He was transferred to the intensive care unit for close monitoring. Followed CT scan from the chest to pelvis revealed a 5.3*4.2 cm hypervascular mass with central necrosis at right atrium. Two-fold elevation of the vanillylmandelic acid level and 12fold elevation of norepinephrine level were noted in a 24hr urine collection. The intracardiac tumor was removed by the cardiovascular surgeon and histopathologic findings confirmed the diagnosis of paraganglioma. Genetic study revealed mutation in the SDHD gene. Catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia are referred to as pheochromocytomas and paragangliomas (PCPGs). These tumors are rare, with an annual incidence of 2 to 8 cases per 1 million people. Intracardiac paragangliomas are extremely rare and account for 2% of all paragangliomas. About 30–35% of patients with PCPGs carry germline mutations. In addition to signs and symptoms that related to elevated circulating catecholamines, patients with intracardiac paraganglioma may have dyspnea, chest tightness or angina for compression of the cardiac chambers or coronary arteries. Increased concentrations of fractionated metanephrines and catecholamines in urine or plasma should be measured to confirm the diagnosis biochemically. CT scan and magnetic resonance imaging are primary imaging modality for localization. Nuclear medicine imaging is helpful in selected patients. For intracardiac paragangliomas, echocardiography is a complementary tool as it presents 77
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detailed description of the tumor and cardiac structures. Coronary angiography provides information about the anatomy between the tumor and coronary circulation. Complete surgical resection is the first treatment option. For unresectable or metastatic diseases, therapeutic strategies include 131I-meta-iodobenzylguanidine (131I-MIBG) therapy, chemotherapy with a CVD protocol (cyclophosphamide, vincristine, dacarbazine) and radiolabeled somatostatin agonists. Novel treatments such as targeted molecular therapies and checkpoint inhibitors may have a role and several clinical trials are ongoing.
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Abstract SE9-2
MALT LYMPHOMA OF BOTH THYROID AND ADRENAL PRESENTING WITH ADRENAL INSUFFICIENCY
甲狀腺及腎上腺黏膜相關淋巴癌 YAO-HSIEN TSENG 曾耀賢 The Division of Endocrinology and Metabolism, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan 童綜合醫院 新陳代謝科
We reported that a 70-year-old female patient presented with a two-week history of intermittent fever and weight loss. Anterior neck swelling rapidly progressed and caused swallowing difficulty during the last two weeks. There was no history of thyroid disease or previous malignancy. Her physician detected hypertension several years ago, but the patient took no specific medication. Thyroid US demonstrated a diffusely enlarged thyroid, diffuse irregular hypoechoic lesions on the left lobe. An abdominal CT scan showed large bilateral masses in the region of the adrenal glands. Primary extranodal lymphoma frequently involves the gastrointestinal tract, Waldeyer’s ring, and the brain, and accounts for 31.5–41% of all non-Hodgkin’s lymphoma (NHL). The prevalence of the thyroid involvement in lymphoma is about 2.5–3% of patients with NHL and most of the involvements occurred in the gland of Hashimoto’s thyroiditis. It has been reported that primary malignant lymphoma accounts for approximately 5% of all thyroid malignancies. Though secondary involvement of the adrenal gland with NHL occurs relatively frequently, primary adrenal lymphoma is extremely rare. We report a patient with MALT lymphoma presenting with simultaneous involvement of two rare extranodal sites thyroid and adrenal with primary adrenal insufficiency.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE9-3
CONCOMITANT ECTOPIC CUSHING SYNDROME AND ZOLLINGERELLISON SYNDROME IN A POSTPARTUM WOMAN
一名產後婦女合併異位庫欣氏症候群和佐林格 - 埃利森症候群 TZU-YUAN WANG 王子源 Division of Endocrinology and Metabolism, Medicine, China Medical University Hospital, Taichung, Taiwan 中國醫藥大學附設醫院內分泌暨新陳代謝系
Introduction: The ectopic ACTH syndrome (EAS) occurs in around 10 % of endogenous Cushing’s syndrome. EAS was first described by Brown in 1928 . Subsequently, this entity was found to be associated with a wide variety of tumors About 50% of the patients with EAS have small cell lung carcinoma in older series. Other causes of EAS includes 10% bronchial carcinoids,10% pancreatic islet cell carcinoma, 5% thymic carcinoid tumor, 5% medullary carcinoma of thyroid, 3% pheochromocytoma and 2% other carcinoid tumors. Zollinger-Ellison syndrome (ZES), first described in 1955, is caused by a non–beta islet cell, gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach to maximal activity, with consequent gastrointestinal mucosal ulceration. ACTH and gastrin-producing pancreatic islet cell carcinomas are extremely uncommon. Here, we present a very rare case of a postpartum woman concomitant EAS and ZES due to islet cell carcinoma with multiple liver metastasis. Case Report: A 27-year-old postpartum woman was admitted to gastroenterology section due to multiple liver and pancreas tumors which were found at local hospital . One month earlier, she had a smooth delivery by caesarean section with a healthy baby. She suffered from poor appetite, non-intentional weight loss of 6 kg, muscle weakness, severe fatigue, depression and cognitive impairment postpartum. High blood pressure (systolic blood pressure 158196 mmHg), severe hypokalemia (K 2.1 mmol/L) and metabolic alkalosis were noted during hospitalization. Pathologic examination of hepatic tumor specimens obtained from liver biopsy revealed ACTH and gastrin-secreting metastatic pancreatic islet cell carcinoma. 80
Abstract Further hormone studies including high cortisol level with lost diurnal variation (cortisol AM 39.53μg/dl, PM 38.63 μg/dl), high ACTH level (ACTH 138 pg/ml), failed to suppress cortisol level in 8 mg high dose dexamethasone suppression test (cortisol 47.44 μg/dl) and high gastrin level >1000 pg/ml were compatible with the diagnosis of EAS and ZES. On the seventh day of hospitalization, she developed moderate amount of tarry stool. Panendoscopy revealed multiple ulcers over the stomach and duodenum. Intravenous proton pump inhibitor was administered. However, gastrointestinal bleeding persisted, duodenotomy was done first, but failed to stop bleeding. Total gastrectomy plus splenectomy were performed later. Finally, the patient died of overwhelming nosocomial infection complicated septic shock. Discussion: ACTH and gastrin-producing pancreatic islet cell carcinoma are rare and the concurrent the two syndromes is extremely uncommon. To our knowledge, the patient was the first reported case of concomitant EAS and ZES due to islet cell carcinoma in a postpartum woman. She presented with both syndromes roughly at the same time. It has been reported that ACTH-producing islet cell tumors are usually malignant and the majority of cases already had liver metastasis at the time of diagnosis. As the previous study, the prognosis of ectopic ACTH and gastrin-producing pancreatic islet cell carcinomas is poor because they usually progress more rapidly and a poor response to therapy. In one review of 53 patients with EAS due to pancreatic islet cell carcinoma, 28% had ZES,80% had metastases, 47% died within 1 year of presentation, 22% survived for 3 years, and only 4% were cured by surgery. Sepsis which developing in our patient and liver failure were the proximate causes of death. The common causes of Cushing’s syndrome in pregnant woman include Cushing’s disease and adrenal tumor. EAS is a very rare presentation. In our case, the patient just had a delivery one month before admission. The typical cushingoid appearance such as central obesity, moon face, and buffalo hump may be masked by pregnancy status. However, high cortisol level was found during surgery of hypokalemia. Consultation of endocrinologist advised to work-up for Cushing’s syndrome. The diagnosis of EAS and ZES due to islet cell carcinoma were soon made not only by positive biopsy stain for ACTH and gastrin in the metastatic hepatic tumors but also hormone data. Conclusion: In a patient who had non-intentional weight loss, hypertension with hypokalemia and multiple gastric, duodenal ulcer. EAS associated with ZES should be highly considered.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SE9-4
PARATHYROID CARCINOMA WITH PRIMARY HYPERPARATHYROIDISM POST SURGICAL INTERVENTION WITH RECURRENCE AND TRACHEAL INVASION POST RADIOFREQUENCY ABLATION OF THYROID TUMOR: A CASE REPORT
副甲狀腺癌併原發性副甲狀腺機能亢進病人經手術術後復發併氣 管侵犯利用射頻燒灼術治療成功之案例報告 WEI CHANG CHEN 陳維常 Department of Endocrinology and Metabolism, Cathy General Hospital, Taipei, Taiwan 國泰綜合醫院內分泌新陳代謝科
Hypercalcemia is a common clinical problem and are mostly caused by primary hyperparathyroidism and malignancy. Hypercalcemia could produce various clinical manifestations from asymptomatic, gastrointestinal symptoms, acute and chronic renal insufficiency to coma status which dependent on acute/chronic or mild to severe hypercalcemia. Severe hypercalcemia which is defined as calcium >14 mg/dL is associated progression of these symptoms and required immediate therapy. Parathyroid carcinoma is a rare cause of primary hyperparathyroidism which accounts for 1-2% and it is common associated with severe hypercalcemia(65-75%). Criteria of diagnosis of parathyroid carcinoma is 1. local invasion of contiguous structures or 2. lymph node or distant metastases. Surgery is the mainstay of therapy for initial treatment, locally recurrent or metastatic disease of parathyroid carcinoma. Medical therapy, including bisphosphonate, denosumab and Cinacalcet is used to control persisted hypercalcemia or unresectable disease. Here we review a case of 63 years old female patient who had thyroid goiter and ever received left partial thyroidectomy about 45 years ago under thyroxine replacement. In 2008, primary hyperparathyroidism with severe hypercalcemia which was caused by right parathyroid adenoma was impressed and treatment for hypercalcemia was done and right parathyroidectomy was performed on 2008/08/25. Persisted hyperparathyroidism and recurrent hypercalcemia(since 2011/01) 82
Abstract were noted and thyroid echogram showed new lesion that located in upper part of right thyroid bed with erosion through thyroid cartilage. Cinacalcet was used since 2012/09 for treating hypercalcemia but hypercalcemia and hyperparathyroidism persisted. Deterioration of renal function and nephrocalcinosis on kidney echogram were noted and larynx CT (2018/08) showed 1.6 cm bi-lobular lesion at right upmost thyroid bed and right subglottic luminal area causing mild airway obstruction. Debulking surgery was performed and but hyperparathyroidism and hypercalcemia persisted. Echo-guided radiofrequency ablation of thyroid tumor was performed on 2019/05/23 and hypercalcemia resolved and level of parathyroid hormone declined over time.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SD1-1 OVERVIEW OF CEREBROVASCULAR DISEASE AND DM
綜論腦血管疾病與糖尿病 SUNG-CHUN TANG 湯頌君 Department Neurology, National Taiwan University Hospital, Taipei, Taiwan 臺大醫院神經部
Cerebrovascular disease (CVD) is the leading cause of mortality and functional disability all over the world. There are several types of CVD and the majority is arterial ischemia (approximately 80%). Major modifiable risk factors for CVD include hypertension, diabetes, smoking and dyslipidemia. Diabetes is a well-established risk factor for CVD which can cause pathologic changes in blood vessels at various locations and can lead to stroke if cerebral vessels are directly affected. It is also known that acute stroke may initiate several mechanisms that lead to hyperglycemia, such as increased innate immunity and stimulation of the hypothalamic–pituitary–adrenal axis. Notably, numerous studies have shown that persistent poststroke hyperglycemia is closely associated with stroke-in-evolution, symptomatic hemorrhagic transformation, hematoma expansion, and unfavorable functional outcomes. In this talk, several issues including the relationship between DM and CVD, hyperglycemia in acute stroke and related management, DM in stroke prevention, etc. will be overviewed and the importance of the cooperation between metabolic specialist and vascular neurologist will be emphasized.
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Abstract SD1-2 BRAIN SMALL VESSEL DISEASE AND DIABETES
腦部小血管疾病與糖尿病 CHIH-PING CHUNG 鍾芷萍 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan 臺北榮民總醫院神經醫學中心神經內科
Brain small vessel disease (SVD) is not only one subtype of stroke, which also contributes largely to dementia and disable in the elderly. Main microvascular pathologies include arteriosclerosis, lipohyalinosis (fibrinoid necrosis), microatheroma and amyloidosis. Compared with hypertension, much less SVD studies have focused on diabetes mellitus (DM). The present talk will review updated evidences about (1) the epidemiology and clinical significances of SVD, (2) pathophysiology of microangiopathy in DM, (3) evidences of causal relationship between SVD and DM, and (4) suggested anti-diabetes medicines regarding SVD prevention.
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SD1-3
DEMENTIA IN DIABETES PATIENTS
糖尿病患的認知功能障礙 PI-SHAN SUNG 宋碧姍 Department of neurology, National Cheng-Kung University Hospital,Tainan, Taiwan 成大醫院 神經部
Cognitive impairment and dementia process is increasingly recognized as an potential comorbidity of diabetes mellitus. Recent researches therefore recommend screening for cognitive dysfunction in older diabetic patients. Cognitive impairment may also lead to barriers of patient’s diabetic control. The early diagnosis of cognitive impairment in diabetic patients may identify the potential patients at a higher risk of developing dementia. It is a challenge for healthcare providers, but is an important issue in diabetes care with significant therapeutic implications. Here, this topic will review the evolving insights regarding the clinical features, potential risk factors, brain imaging and neuropathology, and the proposed mechanisms of diabetic cognitive dysfunction. This topic will also review the potential crosstalks regarding diabetic cognitive dysfunction, Alzheimer’s disease and vascular cognitive impairment. We will also review the potential therapeutic strategies for diabetic cognitive dysfunction.
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Abstract SD2-1 REVIEW AND PROSPECTIVE OF GOAL 50 PROJECT
GOAL 50 計畫回顧與展望 TIEN-JYUN CHANG 張恬君 Department of Internal Medicine, National Taiwan University Hospital,Taipei, Taiwan 國立台灣大學附設醫院 內科部
In Taiwan, there are 2,189,4011 type 2 diabetes patients, the prevalence is around 10%. According to Taiwan Diabetes Atlas_ 2019 Type 2 diabetes, the prevalence of patients elder than 65 y/o is the highest, and the increasing amplitude is also the most rapid. On the other hand, diabetes patients with cardiac and renal complications increased gradually year by year. Therefore, the new idea for diabetes care is “not only blood glucose control, but also control the development of cardiac and renal dysfunction”. The project of “GOAL 50” has been initiated since 2019, and aims to promote more than 50% of type 2 diabetes patients to achieve the goal of HbA1c<7%. The 4 strategies and action plans of “GOAL 50” are advanced care capabilities, improve primary care capacity, optimizing the care payment model, and Inspiring patients to take care of themselves. According to the 2021 PDA application of controlled sugar and kidney protection and the statistical data from integrated diabetes and early CKD Pilot Rewards Program, more than 50% sampled diabetes patients achieving the goal of HbA1c<7%. Therefore, we proposed the vision of next stage “2025 DKD GOAL 50 Diabetes Nephropathy Excellent Care” to attain the following goals: (1) Screening and monitor of renal function and annual urine albumin > 50% (2) Comprehensive assessment of individual comorbidities and follow international guidelines for treatment>50% (3) Diabetic patients with pay-forperformance join Early-CKD program>50%
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SD2-2 GOAL 50: DIABETES AND KIDNEY DISEASE INTEGRATIVE CARE
GOAL50「良程控糖保腎力 : 糖尿病腎病變整合照護第一階段成果」 JUN-SING WANG 王俊興 Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan 台中榮民總醫院 內分泌新陳代謝科
The number of patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) is increasing worldwide. More than half of patients with ESRD have diabetes. This has become an important health care problem in Taiwan. Emerging data revealed that appropriate care of diabetes may decrease the risk of diabetes kidney disease and subsequent complications. Moreover, advances in pharmacologic treatment may help reduce the risk of progression to ESRD in patients with diabetes. Treatment guidelines recommend specific classes of drugs as part of evidence-based treatment for diabetes patients with high risk of cardiovascular and renal disease. We conducted a survey of cardio-renal disease risk and evidence-based drug use in patients with diabetes. I will report the preliminary results in this talk.
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Abstract SD2-3
2022 UPDATE IN TAIWAN GUIDELINE OF DIABETES KIDNEY DISEASE
2022 年糖尿病腎臟疾病指引更新 KUN-DER LIN 林昆德 Division of Endocrinology and metabolism, department of internal medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Diabetic Kidney Disease (DKD) is the major cause of end-stage renal disease (ESRD) in Taiwan and is associated with many kinds of chronic complications such as stroke, ischemic heart disease and congestive heart failure (CHF) in patients with diabetes mellitus. It is a serious problem to prevent the incidence and progression of DKD both in family and public health issues. In recent years, several kinds of anti-diabetic agents including injection and oral forms, showed the great glucose lowering effects and additional kidney protection effects on patients of type 2 diabetes. These large random control trials showed the solids evidences and would affect our treatment of DKD in patients of diabetes. There was also some evidence on the limitations about metformin treatment on patients with DKD. About SGLT2i, in the different stages of DKD, there were different limitations of kidney function on each SLGT2i agent based on their own clinical studies. Empagliflozin is the first one to show the heart and kidney protection effects on patients with DKD. Dapagliflozin and canagliflozin also showed the similar effects after on. However, there were some tiny differences among these trials including the sides effects especially about amputation. The heart protection and kidney function preservation results were similar and tiny differences. GLP-1 injection also provides the great glucose lowering effects on patients with type 2 diabetes and it’s random control trials also showed additional cardiovascular protection and kidney protection in patients with diabetes. However, the protection effects of GLP-1 on DKD seems different from SLGT2i. Based on the different mechanism, further discussion on these two classes of anti-diabetic agents should be dressed more and need more random control trials to prove the effects of combination of these two classes. There are more and more kinds of anti-diabetic agents and we needs more data on 89
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the clinical use of these new generation agents. We should emphasize on the new clinical experiences of these new agents and pay more attention to the updated guidelines to treat our patients with DKD.
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Abstract SD2-4
HOW TO IMPROVE THE QUALITY OF INTEGRATED CARE FOR DIABETIC NEPHROPATHY THROUGH TEAM CARE
如何透過團隊照護提升糖尿病腎病變整合照護品質 I-CHING WANG 汪宜靜 Department of Nursing , National Taiwan University Hospital, Taipei City, Taiwan 臺大醫院護理部
There is one with nephropathy out of three diabetic patients in Taiwan. According to the statistics of the 2019 Annual Report on Kidney Disease in Taiwan, 51.2% of dialysis patients had diabetes. Patients are unaware of the disease due to no obvious symptoms in the early stage of nephropathy. According to the KEEP survey conducted by the National Kidney Foundation, more than 90% of patients with diabetes are unaware that they have chronic kidney disease. So regular screening and monitoring are very important. According to the 2020 survey of 50,000 T2D patients conducted by the Taiwanese Association of Clinic Diabetes, it was found that only half of the patients were aware of their symptoms in 39.7% of diabetic patients with albuminuria. In the self- assessment "Today, are you in control? May I ask the three internal organs of sugar" which was jointly promoted by CTDA (Chinese Taipei Diabetes Association) and TADE (Taiwanese Association of Diabetes Educators), it was also found that diabetic patients had low awareness of their own risk of the kidney disease. Patients without sufficient insight in their illness in the early stage may miss the golden hour of early treatment. We need to rely on the care team to expand screening for the high-risk groups as soon as possible, regularly follow up the changes in renal function, and provide health education. The National Health Insurance Administration has actively promoted the integrated care plan for diabetes and early-stage chronic kidney disease(CKD) since 2021. It is scheduled that UACR and eGFR will be listed as regularly follow-up items for the integrated care. And UACR, HbA1c and LDL are included in the quality indicators to encourage the integrated care. The next steps will be how to screen out high-risk groups in the current care process 91
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
as well as integrate and implement the diabetes and nephropathy health education resources. CTDA and TADE took the lead in the pilot program of integrated care of diabetes and nephropathy in 23 medical centers and regional hospitals, and introduced the PDA (Patient Decision Aid) tool issued by the society. We hope to share our experience with the pilot institutions to communicate effectively with patients in disease education and medication treatment of diabetic nephropathy and promoting integrated care of diabetes and early-stage CKD in the future.
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Abstract SD3-1
DIABETES AND HEPATITIS KEN C. CHIU, MD, FACE, FACP Division of Endocrinology, Department of Internal Medicine, Harbor-UCLA Medical Center, CA, USA
Diabetes is a syndrome complex with a common manifestation of hyperglycemia and its related complications. Except for type 1 diabetes and monogenic diabetes, the underlying causes of diabetes are largely unknown with a notion of genetic contribution. Infection has been implied to play a role in the pathogenesis of diabetes. Among them, the role of hepatitis C virus infection in diabetes is well recognized. Since the liver plays a key role in glucose homeostasis and liver disease is associated with an increased risk for diabetes, we examined the role of hepatitis A and B in the pathogenesis of diabetes. Although hepatitis A infection, based on the presence of anti-hepatitis A antibody and the absence of hepatitis A vaccination, was associated with an increased risk of diabetes (OR: 1.13; 95%CI: 1.08-1.18), hepatitis A vaccination was not associated with diabetes (OR: 1.06; 95%CI: 0.95-1.18), and successful hepatitis A vaccination had no impact on the risk of diabetes (OR: 1.11; 95%CI: 0.97-1.27). Hence, hepatitis A infection was an unlikely cause of diabetes. Alternatively, in non-vaccinated subjects, diabetes increased the risk of hepatitis A infection by 40% (OR: 1.40, 95%CI: 1.27-1.54). Thus, the association between hepatitis A infection and diabetes is observed which is best explained by an increased risk of hepatitis A infection in diabetic patients. Hepatitis B vaccination was not associated with diabetes (OR: 1.08, 95%CI: 0.96–1.23). Serology evidence of hepatitis B immunization, which could be a result of either recovery from hepatitis B infection or vaccination, was associated with a reduced OR of diabetes (0.75, 95%CI: 0.62–0.90). Successful hepatitis B vaccination was also associated with a reduced OR of diabetes (0.67, 95%CI: 0.52–0.84), independently. Therefore, diabetes risk was reduced by 33% in subjects with successful hepatitis B vaccination, implying diabetes prevention via hepatitis B vaccination. To further examine hepatitis B vaccination in diabetic patients, a stepwise decline in hepatitis B seropositivity rate in subjects with normal glucose tolerance (53.64%) to those with abnormal glucose tolerance (45.52%) to those with diabetes (28.84%) was observed 93
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
(P<0.0001). These results were confirmed after standardization for age and BMI and in subgroup analyses by gender and racial/ethnic group. Therefore, dysregulated glucose metabolism is associated with a decreased seropositivity rate after hepatitis B vaccination. Diabetes mellitus is a potentially overwhelming disease with increasing prevalence globally, especially type 2 diabetes. Its complications are associated with significant morbidity and mortality. Therefore, new prevention approaches are needed. The prevalence of hepatitis B increases drastically in the less developed regions of the world, where the prevalence of diabetes is expected to also increase considerably. There is extensive information suggesting that hepatitis B, causing beta cell dysfunction and insulin resistance, is a risk factor for the development of diabetes. Since hepatitis B itself is associated with serious complications and has a significant public health impact, vaccination of hepatitis B at birth will not only prevent hepatitis B-related liver diseases but may also help to prevent diabetes and its complication, especially in the less developed regions. Here, we propose that hepatitis B-induced diabetes is a previously unrecognized complication of hepatitis B infection and a new subtype of type 3 diabetes.
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Abstract SD3-2
A NOVEL ALDH2 ACTIVATOR AD-9308 IMPROVES DIASTOLIC AND SYSTOLIC MYOCARDIAL FUNCTIONS IN STREPTOZOTOCININDUCED DIABETIC MICE 1 1
HSIAO-LIN LEE, 1SIOW-WEY HEE, 1*YI-CHENG CHANG, 1*LEE-MING CHUANG 李曉苓、1 許曉薇、1* 張以承、1* 莊立民
Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan 台大醫院內科部
Diabetes mellitus has reached epidemic proportion worldwide. One of the diabetic complications is cardiomyopathy, characterized by early left ventricular (LV) diastolic dysfunction, followed by development of systolic dysfunction and ventricular dilation at a late stage. The pathogenesis is multifactorial, and there is no effective treatment yet. In recent years, 4-hydroxy-2-nonenal (4-HNE), a toxic aldehyde generated from lipid peroxidation, is implicated in the pathogenesis of cardiovascular diseases. Its high bioreactivity toward proteins results in cellular damage. Mitochondrial aldehyde dehydrogenase 2 (ALDH2) is the major enzyme that detoxifies 4-HNE. The development of small-molecule ALDH2 activator provides an opportunity for treating diabetic cardiomyopathy. This study found that AD-9308, a water-soluble and highly selective ALDH2 activator, can improve LV diastolic and systolic functions, and wall remodeling in streptozotocin-induced diabetic mice. AD-9308 treatment dose-dependently lowered serum 4-HNE levels and 4-HNE protein adducts in cardiac tissue from diabetic mice, accompanied with ameliorated myocardial fibrosis, inflammation, and apoptosis. Improvements of mitochondrial functions, sarco/endoplasmic reticulumcalcium handling and autophagy regulation were also observed in diabetic mice with AD-9308 treatment. In conclusion, ADLH2 activation effectively ameliorated diabetic cardiomyopathy, which may be mediated through detoxification of 4-HNE. Our findings highlighted the therapeutic potential of ALDH2 activation for treating diabetic cardiomyopathy.
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SD3-3
EFFECTS OF NON-NUTRITIVE SWEETENERS DURING PREGNANCY
非營養性甜味劑對妊娠期的影響 KAI-PI CHENG 鄭凱比 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital,Tainan, Taiwan 成大醫院內科部內分泌暨新陳代謝科
Diet modification, weight control and lifestyle changes are the main strategies for glycemic control during pregnancy. Using non-nutritive artificial sweeteners is one way to manage body weight. However, previous studies on the effect of non-nutritive artificial sweeteners on gestational glycaemia were inconclusive. Additionally, some studies have shown that aspartame and its metabolites are toxic to animals. However, the effects of aspartame during pregnancy remain unclear. Therefore, this study aimed to investigate the effects of non-nutritive artificial sweeteners on the glycemic control, placenta and fetuses of pregnant mice. To study the effect of non-nutritive sweetener on pregnancy, pregnant mice were fed different doses of aspartame. Fasting blood glucose levels decreased after aspartame treatment, and there were no significant changes in body weight and serum insulin concentrations in pregnant mice. However, feeding moderate to high doses of aspartame during pregnancy significantly increased systolic blood pressure in pregnant mice. In addition, while aspartame had no effect on fetal number, it did cause a decrease in the weight of the fetus and placenta. Therefore, limiting aspartame intake during pregnancy should be considered.
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PATHOPHYSIOLOGY OF CARDIOVASCULAR DISEASE IN DIABETES
糖尿病心血管病之病理機制 HSIN-BANG LEU, MD, PHD, FACC 呂信邦 Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan 台北榮總健康管理中心 國立陽明交通大學心血管中心
Type 2 diabetes mellitus (DM) is a common metabolic disorder predisposing to diabetic cardiomyopathy and atherosclerotic cardiovascular disease (CVD), which could lead to heart failure through a variety of mechanisms, including myocardial infarction and chronic pressure overload. Pathogenetic mechanisms, mainly linked to hyperglycemia and chronic sustained hyperinsulinemia, include changes in metabolic profiles, intracellular signaling pathways, energy production, redox status, increased susceptibility to ischemia, and extracellular matrix remodeling. The close relationship between type 2 DM and CVD has led to the common soil hypothesis, postulating that both conditions share common genetic and environmental factors influencing this association. In addition, diabetes mellitus elicits cellular, epigenetic, and posttranslational changes that directly or indirectly affect the biology of the vasculature and other metabolic systems resulting in the apparition of cardiovascular disease. Recently, epigenetic factors by different types of reactions are known to be responsible for the interaction between genes and environment and for this reason can also account for the association between diabetes and cardiovascular disease. The impact of clinical factors that may coexistwith diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Furthermore, evidence that justify screening for subclinical atherosclerosis in asymptomatic patients is controversial. Therefore, our review will focus on the association between poor glycemic control, oxidative stress, markers of insulin resistance, and of low-grade inflammation that have been suggested as putative factors linking diabetes and cardiovascular disease.
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SD4-2
UPDATE IN THE TREATMENT OF ASCVD IN DIABETES PATIENTS
糖尿病患的動脈硬化心血管疾病之治療更新 KAI-JEN TIEN 田凱仁 Department of Endocrinology and Metabolism, Chi-Mei Medical Center, Tainan, Taiwan 奇美醫院 內分泌新陳代謝科
Atherosclerotic cardiovascular disease (ASCVD) — defined as coronary heart disease (CHD), cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin — is the leading cause of morbidity and mortality for individuals with diabetes. Numerous studies have shown the efficacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with diabetes. Multifactorial approaches which include glycemic, blood pressure, and lipid management and agents with cardiovascular and kidney benefit should be addressed simultaneously to reduce the risk of diabetes complications. SGLT2 inhibitors and GLP-1 receptor agonists are used in patients with type 2 diabetes as glucose lowering therapies, with additional benefits in reduction of cardiovascular risk factors. Data from cardiovascular outcome trials (CVOTs) have highlighted that these drugs confer protection against major cardiovascular disease in those with established atherosclerotic cardiovascular disease, reduce the risk of admission to hospital for heart failure, and reduce cardiovascular and all-cause mortality. The position of SGLT2 inhibitors and GLP-1 receptor agonists as glucose lowering therapies in treatment algorithms in people with type 2 diabetes has been updated reflecting results of these CVOTs. Both drug classes reduce bodyweight, HbA1c , and other intermediate markers of cardiorenal health (blood pressure, UACR, or eGFR). The cardiovascular risk reduction seen with SGLT2 inhibition is partly explained by the glycosuric effect and associated plasma volume reduction, whereas the benefits of GLP1 receptor agonists relate to potentially complementary anti-atherogenic mechanisms. Hence, SGLT2 inhibitors and GLP-1 receptor agonists are now recommended in patients with type 2 diabetes and those at a high risk or with established CVD, irrespective of baseline HbA1C or metformin use in 2022 American Diabetes Association recommendations. 98
Abstract SD4-3
UPDATE IN THE TREATMENT OF HEART FAILURE IN DIABETES PATIENTS
治療心衰竭糖尿病患的最新進展 CHO-KAI WU 吳卓鍇 Department Cardiology, National Taiwan University Hospital, Taipei, Taiwan 臺大醫院心臟科
This is an introduction to this special issue on diabetes and heart failure (HF). The issue deals with the primary features and key questions regarding the coexistence of diabetes and heart failure. Evidence for most treatments of this disease state comes from post hoc analysis of clinical trials and registries. Recent evidence shows a significant decrease in HF-related events with the newer antidiabetic agents. Therefore, in this issue, we briefly summarize the most relevant cardiovascular outcome trials supporting the use of newer antidiabetic drugs beyond traditional glucose-lowering agents. Notably, this issue focuses on the important effects of antidiabetic drugs in specific population, namely, the elderly; patients with HF with preserved ejection fraction; and patients with pulmonary hypertension, as well as specific conditions related to muscle, pulmonary, and renal metabolism.
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SD5-1
PATHOPHYSIOLOGY OF DYSLIPIDEMIA
異常血脂症之疾病生理 WEI-SHIUNG YANG 楊偉勛 Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 臺大醫院內科部內分泌新陳代謝科
In order to set the stage for this symposium and the following two lectures about lipid treatment guidelines, a brief review of lipoprotein metabolism and transport will be given in this lecture. An overview of how food lipid is absorbed by intestine into blood circulation and metabolized; and further how lipoprotein is produced by liver in fasting state will be addressed at whole-organism physiology-level. Some more details about low density lipoprotein-cholesterol (LDL-C) homeostasis will be given to highlight the mechanism of LDL-C lowering strategies at present. At the end, a brief overview of the pathogenic mechanisms of primary and secondary lipid disorders and atherosclerosis will be discussed to conclude this lecture.
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2022 TAIWAN LIPID GUIDELINES FOR PRIMARY PREVENTION
2022 台灣血脂治療之初級預防 PO-HSUN HUANG 黃柏勳 Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. 台北榮民總醫院心臟內科，陽明交通大學心臟血管疾病研究中心
Cardiovascular (CV) disease, including atherosclerotic cardiovascular disease (ASCVD), is one of the major leading causes of death in Taiwan. Accumulating evidence from laboratory, epidemiological, and genetic studies indicates that increased circulating low-density lipoprotein cholesterol (LDL-C) causes accelerated deposition of cholesterol in the arterial wall leading to vascular inflammation and atherosclerosis. The causal link of LDL-C and ASCVD was further proved in many clinical trials showing that intensive reduction of LDL-C is an effective therapy to attenuate the progression of coronary atherosclerosis and improve CV outcomes. Recent studies demonstrated that in individuals without advanced coronary atherosclerosis, early initiation of statin therapy to decrease LDL-C could obtain a similar CV risk as those with untreated low LDL-C levels. It is clear that maintaining an adequate LDL-C level earlier in life is an effective intervention for the prevention of ASCVD. However, the control rate of LDL-C is disappointing in Taiwan. Even in patients with ASCVD, only 54% of them could achieve an LDL-C level < 100 mg/ dL. The Taiwan Society of Lipids and Atherosclerosis, in association with seven other major societies in Taiwan, published the Taiwan Lipid Guidelines for High-Risk Patients in 2017. However, the management of dyslipidemia was not mentioned for subjects without the above-mentioned high-risk features in the 2017 guidelines. The Taiwan Society of Lipids and Atherosclerosis decided to move forward to primary prevention and developed a new lipid guideline targeting the subjects without clinically significant ASCVD, but may carry other various vascular risk factors. Here, we will briefly introduce the 2022 Taiwan Lipid Guidelines for primary prevention in this lecture.
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SD5-3
LIPID GUIDELINES FOR SECONDARY PREVENTION CHAU-CHUNG WU, M.D., PH.D. 吳造中 Department of Internal Medicine (Cardiology Section), National Taiwan University Hospital, Taipei, Taiwan
Lipid control is important in the secondary prevention for the patients with existed atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), ischemic stroke and peripheral arterial disease (PAD). Elevated low-density lipoprotein cholesterol (LDL-C) is a principally modifiable cause of ASCVD; accordingly, recent European, US and Taiwanese multisociety dyslipidaemia guidelines emphasise the importance of lowering LDL-C to reduce CV risk. As a core focus of preventive therapy, both European and US lipid management guidelines emphasise the importance of identifying patients at very high cardiovascular risk and treating to achieve LDL-C levels as low as possible, with European guidelines setting a goal of <1.4 mmol/L (<55 mg/dL) in patients with very highrisk cardiovascular disease. However, we Taiwanese need to modify and validate these scoring systems for our own society, to fulfil an important unmet need for very high-risk patients who are not able to achieve LDL-C goals with conventional agents.
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Abstract SD6-1
PHARMACOLOGIC APPROACH TO AMELIORATE GLUCOLIPOTOXICITY OF PANCREATIC BETA CELLS
改善胰臟 BETA 細胞糖脂質毒性的藥理學方法 TIEN-JYUN CHANG 張恬君 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 國立台灣大學附設醫院 內科部
Rosiglitazone (RSG), an insulin sensitizer can enhance glucose-stimulated insulin secretory capacity of β cells through PI-3 kinase pathway in Sprague-Dawley rats. Furthermore, we has found RSG potentiates insulin secretion via PI-3 kinase dependent activation of AMP-dependent protein kinase (AMPK) and closure of KATP channel, then elevates the membrane potential of β cells, ultimately leads to stimulate insulin secretion in a mouse insulinoma cell line, MIN6 and rat primary islets. Accumulation of methylglyoxal (MG) contributes to glucotoxicity and mediates beta cell apoptosis. MG treatment induced apoptosis of beta cells, impaired mitochondrial function, and prolonged activation of AMP-dependent protein kinase (AMPK). The MG-induced proapoptotic effects were abolished by an AMPK inhibitor. Pretreatment of GLP-1 reversed MG-induced apoptosis, and mitochondrial dysfunction, and suppressed prolonged AMPK activation. Pretreatment of GLP-1 reversed AMPK activator 5-aminoimidazole-4-carboxamide riboside (AICAR)-induced apoptosis, and suppressed prolonged AMPK activation. In parallel, GLP-1 also prevents MG-induced beta cell apoptosis through PKA and PI3K-dependent pathway. In conclusion, these data indicates GLP-1 protects MG-induced beta cell apoptosis through improving mitochondrial function, and alleviating the prolonged AMPK activation. Chronic hyperglycemia and hyperlipidemia hamper beta cell function, leading to glucolipotoxicity. Mitochondrial aldehyde dehydrogenase 2 (ALDH2) detoxifies reactive aldehydes, such as methylglyoxal (MG) and 4-hydroxynonenal (4-HNE), derived from glucose and lipids, respectively. We found that Alda-1 enhanced glucose-stimulated insulin secretion (GSIS) by improving the mitochondrial function of pancreatic beta cells. Alda-1 103
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
rescued MIN6 cells from MG- and 4-HNE-induced beta cell death, apoptosis, mitochondrial dysfunction, and reactive oxygen species (ROS) production. However, the above effects of Alda-1 were abolished in Aldh2 knockdown MIN6 cells. In conclusion, we reported that the activator of ALDH2 not only enhanced GSIS, but also ameliorated the glucolipotoxicity of beta cells by reducing both the mitochondrial and intracellular ROS levels, thereby improving mitochondrial function, restoring beta cell function, and protecting beta cells from apoptosis and death.
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STUDY OF THE THERAPEUTIC EFFECT OF MESENCHYMAL STEM CELLS IN TYPE 1 DIABETES
運用間質幹細胞治療第一型糖尿病之研究 1,2,3
PEI-JIUN TSAI, 1,2,4 TIEN-HUA CHEN
1,2,3
蔡佩君、1,2,4 陳天華
1
Institute of Anatomy and Cell Biology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; 2Trauma Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; 3 Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; 4Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC 1
國立陽明交通大學 解剖學及細胞生物學研究所、 2 臺北榮民總醫院 外科部外 ( 創 ) 傷中心、 3 臺北榮民 總醫院 重症醫學部重症加護外科、 4 臺北榮民總醫院 外科部一般外科
Type 1 diabetes mellitus (T1DM) is caused by T cell-mediated autoimmune destruction of pancreatic βcells. Systemic administration of mesenchymal stem cells (MSCs) brings about their incorporation into a variety of tissues with immunosuppressive effects, resulting in regeneration of pancreatic islets. The insulin-producing cells (IPCs) differentiated from mesenchymal stem cells (MSCs) in human tissues including surgically resected pancreatic tissue, bone marrow (BM) and Wharton’s jelly of umbilical cord could decrease blood glucose level and improve the survival rate in Streptozotocin (STZ) induced type 1 diabetic rats. MSCs from Wharton’s Jelly of human umbilical cord were the most promising stem cell source for β-cell regeneration in treatment of type 1 diabetes. However, the underlying mechanisms are unclear. Undifferentiated WJ-MSCs underwent lentiviral transduction to express green fluorescent protein (GFP) and then were injected into the retro-orbital venous sinus of NOD mice. Seven days after transplantation, fluorescent islet-like cell clusters in the pancreas were apparent. WJ-MSC-GFP-treated NOD mice had significantly lower blood glucose and higher survival rates than saline-treated mice. Systemic and local levels of autoaggressive T cells, including T helper 1 cells and IL-17-producing T cells, were reduced and regulatory T cell levels were increased. Furthermore, anti-inflammatory cytokine levels were increased and dendritic cells were decreased. At 23 days, higher human C-peptide and serum insulin levels and improved glucose tolerance were found. Additionally, WJ-MSCs-GFP differentiated into
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IPCs as shown by colocalization of human C-peptide and GFPin the pancreas. Significantly more intact islets and less severe insulitis were observed. In conclusion, undifferentiated WJMSCs candifferentiate into insulin-producing cells in vivo with immunomodulatory effects and repair the destroyed islets in NOD mice.
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Abstract SD6-3
FUNCTIONAL AND MECHANISTIC STUDIES OF PDIA4 IN TYPE 2 DIABETES
PDIA4 在糖尿病的功能和機制探討 WEN-CHIN YANG 楊文欽 Agricultural Biotechnology Research Center, Academia Sinica, Taipei, Taiwan 中央研究院 農業生物科技研究中心
Globally, 537 million people live with diabetes, which causes about 5 million deaths annually. Diabetes is characterized by a failure of functional β-cells to adapt insulin secretion to compensate for increasing insulin resistance, driving diabetes development. Loss of β-cell number and function is central to diabetes development Thus, β-cell preservation is emerging as a promising strategy to treat and reverse diabetes. Here, we first found that Pdia4 was primarily expressed in β-cells. This expression was up-regulated in β-cells and blood of mice in response to excess nutrients. Ablation of Pdia4 alleviated diabetes as shown by reduced islet destruction, blood glucose and HbA1c, reactive oxygen species (ROS), and increased insulin secretion in diabetic mice. Strikingly, this ablation could fully reverse diabetes. Conversely, overexpression of Pdia4 had the opposite pathophysiological outcomes in the mice as evidenced by increased islet atrophy, blood glucose, HbA1c, reactive oxygen species (ROS), and impaired insulin secretion. In addition, Pdia4 positively regulated β-cell death, dysfunction and ROS production. Mechanistic studies demonstrated that Pdia4 increased ROS content in β-cells via its action on the pathway of Ndufs3 and p22phox. We also developed one Pdia4 inhibitor, PS001, using a combination of virtual screening and chemical synthesis. PS001 suppressed diabetic development in diabetic mice. Investigational dug (IND) of PS001 were approved by FDA. These findings characterize Pdia4 as a crucial regulator of β-cell pathogenesis and diabetes, suggesting Pdia4 is a novel therapeutic and diagnostic target of diabetes.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
SD7-1
INTRODUCTION AND RATIONALE OF THE TYPE 1 DM GUIDELINE GUIDELINES
第 1 型糖尿病臨床照護指引說明與簡介 YI-JING SHEEN 沈宜靜 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 台中榮民總醫院 內分泌暨新陳代謝科
The incidence and prevalence of type 1 diabetes (T1DM) variants by region and ethnicity. The global prevalence of T1DM is 5.9 per 10,000 people and the patient number rising rapidly. The current incidence is about 15 per 100,000 people per year in the past decades and was underestimated. To cause attention for taking T1DM seriously, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) publish the first consensus report on the management of type 1 diabetes in adults in 2021. In addition, it is the first time, the international diabetes federation (IDF) presented T1DM prevalence in different stages of life in the 10th IDF Diabetes Atlas published in 2021. In Taiwan, T1DM accounted for <0.6% of the entire diabetic population, showing a slight increase past decade, the standardized prevalence of T1DM increased from 0.04% to 0.05%. The standardized incidence of T1DM slightly decreased, however, the age-standardized incidence rates were roughly flat. The results may be responsible by the simultaneous decline of the numerator and denominator due to the low birthrate. The prevalence and incidence of T1DM in women were higher than that in men. Notably, though T1DM was the main type of diabetes in childhood, the incidence peaks in adolescence and early adulthood, however, it can occur at any age. In Taiwan, about 40% of new-onset T1DM were adults, the worrying emergence of T1DM in adults has been recognized, while the relatively low prevalence in Taiwan. To face the challenge, the Taiwanese Association of Diabetes of Educators, the Diabetes Association of the Republic of China (Taiwan), and the National Health Research
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Abstract Institutes published the first Yearbook of T1DM in 2020, which updates the epidemiology and management of T1Dm in Taiwan. To go a step further, the Diabetes Association of the Republic of China (Taiwan) convened a working group to develop a clinical practice guideline for the management of T1DM. Our working group has addressed the following topics: epidemiology, pathophysiology, diagnosis, and screening, the aim of management, glucose monitoring, lifestyle modification, nutrition, weight control, vaccination, psychosocial care, behavioral considerations, insulin therapy, insulin pump, acute complications including hypoglycemia and diabetic ketoacidosis, chronic complications (micro-and macrovascular complications), comorbidities, patient-centered care, schedule of care, diabetes self-management education and support, transition care, special populations, inpatient management, adjunctive therapies, pancreas and islet transplantation, future perspectives, and pay for performance program for diabetes. Our working group also introduce the new treatments and technologies and aimed to highlight the key points health care professionals should consider when managing patients with T1DM.
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SD7-2
DIAGNOSIS OF TYPE 1 DIABETES MELLITUS
第 1 型糖尿病診斷 CHIA-HUNG LIN 林嘉鴻 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City33302, Taiwan 林口長庚醫院 內分泌暨新陳代謝科
Although type 1 diabetes mellitus (T1DM) is a recognized a catastrophic disease among the different types of diabetes, it is often confusedly diagnosed in clinical practice and difficult in care. A multidisciplinary consensus for the establishment of clinical recommendations on T1DM is established to optimize its undoubtedly diagnostic evaluation and transitional care. The C-peptide/glucagon test is crucial for T1DM diagnosis and the diagnosis of LADA or slow-evolving immune-mediated diabetes should be distinguished from that of T1DM. Positive GAD65/IA-2/ZnT8 antibody test results can confirm that a patient has T1DM. However, testing negative for these antibodies cannot exclude the possibility that a patient has this disease. For patients aged ≥18 years, the C-peptide/glucagon test cutoff for indicating the presence of T1DM is set at a C-peptide concentration of <0.5 ng/mL at 0 min, of <1.8 ng/mL at 6 minutes, or of <0.7 ng/mL. For patients aged<18 years, the C-peptide cutoff is<0.5 ng/mL at 0 minute or <3.3 ng/mL at 6 minutes. These recommendations serve as a valuable tool for improving the clinical diagnosis and care of patients with T1DM. Moreover, further studies should be conducted to resolve doubt and standardize professional opinion regarding certain aspects of T1DM diagnosis in Taiwan.
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SPECIAL ATTENTION FOR PEDIATRIC TYPE 1 DIABETES PATIENTS
兒童第 1 型糖尿病特別關注事項 YI-CHING TUNG 童怡靖 Pediatric Endocrinology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan 台大醫院小兒部 兒童內分泌科
According to the Taiwan's National Health Insurance Database, sixty percent of type 1 diabetes (T1D) patients had their disease onset in the childhood or adolescents. The clinical presentations, differential diagnosis, developmental consideration, and response to therapy are distinct in these pediatric T1D. These young-onset T1D patients live with diabetes through the stages of infancy, childhood, adolescences, and adulthood. Therefore, the care providers should be familiar with the care and management in (1) changes in the therapy related to physical growth and puberty, (2) prevention of short-term crisis due to neurological vulnerability to hypoglycemia and hyperglycemia in young children, (3) the education for the patients and family, especially the transition from caregiver’s care to self-care, (4) the psychosocial support for the emotional instability, especially at disease onset and in the adolescents. A shared care team of specialists, including pediatric endocrinologist, nurses, dieticians, and mental health professionals, is essential in the good care for the pediatric T1D. Nutrition therapy with annual updates is important. Exercise is recommended with education on strategies to prevent hypoglycemia. Glycemic control with A1C goals must be individualized and reassessed over time. Good glycemic control depends on (1) frequent glucose monitoring, including self-monitor blood glucose levels (SMBG) or continuous glucose monitoring (CGM), and (2) intensive insulin delivery, either via multiple daily injections or continuous subcutaneous insulin infusion (CSII), which should be considered in all pediatric T1D.
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SD7-4
CTDA 2022 CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF TYPE 1 DIABETES MELLITUS: EXECUTIVE SUMMARY
中華民國糖尿病學會 2022 年第 1 型糖尿病照護指引 : 執行摘要 TIEN-JYUN CHANG 張恬君 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 國立台灣大學附設醫院 內科部
According to Taiwan's 2000-2016 Health Insurance Database, as of 2016, there were about 11,597 type 1 diabetes patients in Taiwan, with a prevalence rate of about 50 patients per 100,000 population, and an incidence rate of about 2.23 new cases per 100,000 people per year-patient. The executive summary will provide a brief and unified description of the diagnosis, treatment goals, management procedures, clinical testing, and glycemic control of inpatients with type 1 diabetes mellitus in children, adolescents and adults.
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ASSESSING BONE MINERAL DENSITY AND FRACTURE RISK IN PATIENTS WITH DIABETES
糖尿病病人的骨質密度與骨折風險評估 CHAO-JAN WANG 王超然 Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 林口長庚醫院 影像診療部
Previous studies have revealed that diabetes mellitus (DM) is associated with decreased bone strength as well as increased fracture risk. In type 1 diabetes, bone mineral density (BMD) is generally decreased, while in type 2 diabetes, BMD appears conflicting. DMinduced bone fragility has been recently recognized as a diabetic complication and the fracture risk is independent of the reduction in bone mineral density, deterioration of the bone quality may be the main cause of bone fragility. Osteoporosis and several other DM complications (e.g. visual impairment and gait imbalance) increase the risk of falls, fragility and low-impact fractures. In clinical practice, physicians can assess the risk of fracture for a patient by using the FRAX, an assessment tool that estimates the 10-year probability of hip fracture and major osteoporotic fractures based on the individual's risk factors profile. Some studies showed that FRAX underestimated observed major osteoporotic and hip fracture risks in diabetics but demonstrated good concordance with observed fractures for nondiabetics. The diagnosis of osteoporosis is currently based on BMD assessed by dual-energy X-ray absorptiometry (DXA) scans. Among widely recognized limitations of BMD is that BMD considers only the density of the bone and fails in measuring bone microarchitecture. Trabecular bone score (TBS) is derived from the texture of the spine DXA image and is related to bone microarchitecture, providing information independent of BMD and FRAX. A recent meta-analysis study showed that type 2 diabetes was associated with decreased TBS and also prediabetes had significantly lower TBS. Lumbar spine TBS may be a potential supplementary tool to predict osteoporotic fractures and offer an enhanced estimation of fracture risk in those patients with diabetes. 113
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SD8-2
ROLE OF BONE MICROSTRUCTURE IN DIABETES BONE FRAGILITY JENG-FU KUO 郭仁富 Section of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan 彰化基督教醫院 內分泌新陳代謝科
T2DM patients have normal or high bone mineral density (BMD) but an increased risk of fractures. The possible mechanism may be due to alterations of bone microarchitecture that impaire bone strength. Chronic hyperglycemia leads to the formation of advanced glycation end products (AGE). The aggregation of AGEs causes non-enzymatic cross-linking of type 1 collagen, disrupting the adhesion of osteoblasts to the extracellular matrix and resulting in bone fragility. These changes of extracellular matrix impair bone mineralization by reducing alkaline phosphatase (ALP) activity in mature osteoblasts. The stimulation of receptor for AGEs (RAGE) drives the activation of nuclear factor kappa-B (NF-kB) in osteoclasts, increasing the production of cytokines and reactive oxygen species (ROS) which trigger osteoclastogenesis and stop osteoblast differentiation. Several tools, such as high resolution peripheral quantitative computed tomography (HR-pQCT), finite element analysis, and bone biopsy have been developed for evaluation of bone microarchitecture in diabetes. However, these tools have several provisos, such as high cost, radiation exposure, invasiveness, and limited availability. Trabecular bone score (TBS) is a textural analysis of the lumbar spine dual energy X-ray absorptiometry (DXA) images, providing an indirect index of trabecular microarchitecture. Higher values of TBS indicate a better microarchitecture, whereas lower values indicate a degraded microarchitecture. TBS predicts fracture risk independent of BMD and enhances capabilities of Fracture Risk Assessment Tool (FRAX®). Differently than BMD, TBS is lower in diabetics than nondiabetics. In general, combining TBS and BMD improves fracture prediction in diabetes.
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IMPLICATIONS FOR OSTEOPOROSIS TREATMENT IN DIABETIC PATIENTS
糖尿病患骨質疏鬆治療的意義 CHIA-JEN TSAI 蔡嘉仁 Division of Endocrinology and Metabolism, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 高雄長庚醫院 內分泌暨新陳代謝科
Osteoporosis and diabetes mellitus represent global health problems due to their high, and increasing with aging, prevalence in the general population. Increased fracture risk represents an emerging and severe complication of diabetes. The resulting prolonged immobility and hospitalization can lead to substantial morbidity and mortality. Pathophysiology of the two disorders and related complications is multifactorial, and several mechanisms are now fully recognized. Experimental data have shown the significant detrimental effect that the perturbation of glucose metabolism has on the skeleton. Studies on the endocrine function of the skeleton allowed the identification of mechanisms through which bone can modulate glucose homeostasis. There have been multiple reports of antidiabetic drugs affecting the skeleton, with differences among basic and clinical research data, as well as of anti-osteoporosis medication influencing glucose metabolism. Moreover, there are insufficient data to clarify whether there are any differences in the efficacy of antiosteoporotic drugs on fracture incidence between diabetic and nondiabetic patients with osteoporosis.
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SD9-1
VIRAL HEPATITIS AND DIABETES
病毒性肝炎與糖尿病 HUNG-CHIH YANG 楊宏志 Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 台大醫學院微生物學科、台大醫院內科部
Chronic viral hepatitis, including hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, is a major problem of global public health, leading to a spectrum of liver diseases, namely, cirrhosis and hepatocellular carcinoma. The incidence and prevalence of diabetes mellitus (DM) has also been increasing in the past decades. The liver has insulin receptors and plays an important role in glucose metabolism, so it is of clinical interest to understand the interplay between chronic viral hepatitis and DM. The relationship between chronic hepatitis B or hepatitis C and DM has been extensively studied. The role of HBV infection in DM development remains controversial, whereas HCV infection has been shown to increase insulin resistance and the risk of DM. Although the effect of HBV infection on insulin is not fully understood, previous mechanistic studies have demonstrated that chronic HCV infection results in dysregulation of pathways in glucose metabolism, eventually leading to insulin resistance and development of DM. In addition, insulin resistance affects the response to antiviral treatment against HCV. Sustained virological response to antiviral treatment or cure of chronic HCV infection can improve or even reverse insulin resistance, so better glycemic control can be achieved. Furthermore, DM is closely associated with non-alcoholic fatty liver disease (NFALD), which further enhances the risk of adverse outcomes of chronic viral hepatitis. To summarize, this talk will review and discuss the relationship between chronic viral hepatitis and DM.
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Abstract SD9-2
NON-ALCOHOLIC FATTY LIVER DISEASE
非酒精性脂肪肝病 JEE-FU HUANG, M.D., PH.D. 黃志富 Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 高雄醫學大學附設醫院 肝膽胰內科、肝炎中心
Nonalcoholic fatty liver disease (NAFLD) has been recognized as the most prevalent liver disease worldwide. The global prevalence is estimated to be 25% and it was higher in the Westernization regions. From the liver histological point of view, NAFLD is a spectrum of disease ranging from simple steatosis to the more severe form of steatohepatitis. Nonalcoholic steatohepatitis (NASH) was defined by histopathologic evidence as an extreme form of NAFLD. In contrast to simple steatosis group, NASH patients showed progressive features with higher liver-related mortality. A certain proportion of the patients ultimately progress to fibrosis/cirrhosis and potentially hepatocellular carcinoma (HCC). Although the mechanisms are not fully understood, its associated cryptogenic cirrhosis and HCC provide the evidence of the progressive nature of NASH. Many clinical factors had been reported to be associated with NASH progression, including age, obesity, metabolic conditions, and concomitant chronic virus infection. Accurate determination of the presence and extent of liver fibrosis is essential for prognosis and for management planning in NAFLD patients. Baseline fibrosis stage at initial biopsy has been shown to be correlated with liver-related complications and mortality. In addition, the ethnicity may play a key role in disease progression, particularly in Asians who are more susceptible to NASH given the same level of body mass index (BMI) in other races. However, the characteristics of disease progression in NASH patients have rarely been investigated based on the histopathological changes in Asia. Nevertheless, NAFLD in itself has a low fatality for liver diseases. Although a high proportion of the population has NAFLD, only a minority progresses to advanced liver
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disease or liver-related death. It’s commonly associated with related metabolic diseases, leading to cardiovascular events as its leading cause of death. The metabolic disorders include abdominal obesity, hypertension, dyslipidemia and insulin resistance (IR) and further increase the risk of cardiovascular disease, type 2 diabetes mellitus and chronic kidney disease. More efforts are needed to elucidate the underlying mechanisms leading to different phenotypic presentations of NAFLD, which will be informative for elucidating the real scenario of the global liver disease.
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Abstract SD9-3
RECENT ADVANCES IN THE DEVELOPMENT OF TREATMENT FOR NON-ALCOHOLIC FATTY LIVER DISEASE KUEI-CHUAN LEE 李癸汌 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 臺北榮民總醫院 胃腸肝膽科
Non-alcoholic fatty liver disease (NAFLD) has been the most prevalent chronic liver disease in the world. The treatment includes life style modification, pharmacologic therapy, and non-pharmacologic therapy. Weight reduction by life style modification, or surgery is the most effective therapy currently. However, vitamin E, pioglitazone, obeticholic acid had been suggested in some patients of NAFLD. In this talk, I will introduce newly clinical trials in NAFLD and some experimental therapies for NAFLD.
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ESROC-KES-1
SAFETY OF ANTITHYROID DRUG THERAPY IN PREGNANCY DR. TAE HYUK KIM Div. of Endocrinology & Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
The thionamide antithyroid drugs, methimazole (MMI), its pro-drug derivative carbimazole (CMZ), and propylthiouracil (PTU) are the mainstay of treatment for hyperthyroidism in pregnancy. However, antithyroid drugs carry risks of adverse effects that can affect fetal and maternal well-being. Using a Korean health insurance database, We studied 2.9 million pregnancies resulting in live births from 2008 through 2014. Congenital malformations were detected in 7.3% of pregnancies with first-trimester antithyroid drug exposure and 5.9% of unexposed pregnancies. After multivariable adjustment, methimazole exposure conferred a 31% increase in risk, and PTU exposure a 16% increase in risk, relative to no exposure (translating to 17 and 9 additional cases of congenital malformation per 1000 live births). Methimazole showed a dose-response effect. Of note, switching from methimazole to PTU after pregnancy detection, as guidelines recommend, did not reduce risk. We suggest that guidelines be reconsidered, as "switching may pose a substantial risk ... through exposure to different teratogens in a sequential manner." Additionally, our findings confirm the importance of limiting methimazole use during the first trimester of pregnancy. The speaker will share an update of the safety of antithyroid drugs in pregnancy, focusing on the most serious concerns of congenital malformations.
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Abstract ESROC-KES-2
EPIDEMIOLOGY, SURVIVAL AND DEATH CAUSES OF THYROID CANCER IN TAIWAN, AND BEYOND
台灣甲狀腺癌的流行病學、生存和死亡原因，及未來展望 SHU-FU LIN 林樹福 New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), Division of Endocrinology and Metabolism, New Taipei City, Taiwan 新北市立土城醫院 ( 委託長庚醫療財團法人興建經營 ) 內分泌暨新陳代謝科
The incidence of thyroid cancer has increased substantially worldwide. By analyzing data of Taiwan Cancer Registry, the age-standardized incidence of thyroid cancer increased from 5.66 per 100,000 person-years in 1997 to 12.30 per 100,000 person-years in 2012, with an average annual percentage change of 5.1. However, the overall mortality risk and actual causes of death in thyroid cancer patients are not clear. Patients with thyroid cancer diagnosed between 2001 and 2017 were analyzed from Taiwan’s National Health Insurance Research Database. We compared these patients with control subjects matched for age, gender, history of cardiovascular disease (CVD), hyperlipidemia, diabetes mellitus, hypertension, and occupation to assess the risk of overall mortality and cause-specific mortality. Finally, our cohort comprised 30,778 patients with thyroid cancer. Three hundred and ninety-eight deaths (1.29%) occurred during a median followup of 60.0 months (range: 30.3 to 117.6 months). The primary cause of death was thyroid cancer mortality (31.2%), followed by other malignancy-related mortality (29.9%) and CVD mortality (12.3%). The overall mortality risk was similar between the thyroid cancer and control groups (unadjusted hazard ratio (HR): 0.98; 95% confidence interval (CI): 0.88–1.10); the adjusted HR was 1.07 (95% CI: 0.95–1.20) after multivariate adjustment for age, gender, history of CVD, hyperlipidemia, diabetes mellitus, hypertension, and occupation. The risk of other malignancy-related mortality was comparable between two groups. CVD mortality risk was lower in the thyroid cancer group, with an unadjusted HR of 0.51 (95% CI: 0.38–0.69)
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and adjusted HR of 0.56 (95% CI: 0.42–0.76). Patients with thyroid cancer had excellent overall survival. Thyroid cancer-specific mortality was the leading cause of death, highlighting the importance of novel treatments for patients with refractory thyroid cancer. Thyroid cancer patients had lower CVD mortality risk than the general population.
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Abstract ESROC-KES-3
ASSOCIATION OF METABOLIC CHANGES WITH SUBTLE DIFFERENCE IN THYROID FUNCTION: FINDINGS FROM KOREAN NATIONAL HEALTH AND NUTRITIONAL EXAMINATION AND SURVEY (KNHANES) MIN-HEE KIM Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
Korean National Health and Nutrition Examination Survey (KNHANES) is ongoing surveillance system initiated in 1998. The health and nutritional status of Korean are assessed in the survey. The main purpose of KNHANES is to provide background data for health policies and programs for Korean. For this purpose, information related to health risk factors and major chronic diseases are obtained. Thus, prevalence and control status of major chronic disease could be evaluated in KNHANES. Health behaviors, such as exercise, smoking and drinking, which would have significant effects on chronic disease, are also described. Additionally, detailed information about food intake in terms of nutrition as well as socioeconomic status is acquired in the survey. Thus, it could be very attractive data not only for policy makers but also for clinical researchers. From KNHANES IV (2013-2015) released in 2016, information specifically related to thyroid disease were included. Detailed survey on specific types of thyroid disease, treatment, and intake of seaweed were obtained. Also, questionnaires about use of thyroid ultrasound were included. Especially, serum thyrotropin, free thyroxine, thyroperoxidase antibody and urine iodine were measured in 2,400 subsampled population, one third of total. Therefore, many researchers utilized KNHANES to find associations between clinically relevant parameters and thyroid disease (or function) in noninstitutionalized population. Among many possible clinical parameters in KNHANES, it is very interesting to evaluate the relationship metabolic parameters with thyroid function as thyroid hormones are important determinants of glucose and lipid metabolism. Thyroid hormones act on glucose homeostasis in various peripheral organs particularly the pancreas, muscle, adipose tissue, and liver, and thyroid hormones also exert central effects. In particular, the roles of thyroid hormones in 123
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peripheral tissues have been extensively studied at the molecular level. For example, thyroid hormones regulate several key molecules in gluconeogenesis, such as phosphoenolpyruvate carboxykinase and glucose-6-phosphatase. Alanine transport and its conversion to glucose in the liver were observed to be increased by thyroid hormones. These hormones also contribute to hepatic insulin resistance, mainly via carbohydrate-response element-binding protein. Conversely, it also exerts effects on glucose consumption. In addition, thyroid hormones play a crucial role in the differentiation of skeletal muscle and muscle energy expenditures. However, there is not conclusive findings, especially in large population data, whether subtle difference in thyroid function would make changes in metabolic adverse outcomes or not. In this context, KNHANES, representative data of Korean population, is attractive data to elucidate the association of metabolic changes with subtle difference in thyroid function. We are going to share our experience of utilizing KNHANES and findings in terms of metabolic changes (ex. glucose homeostasis, lipid metabolism, non-alcoholic fatty liver, and sarcopenia) and thyroid function.
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Abstract ESROC-KES-4
SERUM FIBROBLAST GROWTH FACTOR 23 AND MINERAL METABOLISM IN PATIENTS WITH EUTHYROID GRAVES’ DISEASES: A CASE-CONTROL STUDY
甲狀腺功能正常之葛瑞夫氏症患者血中之纖維細胞生長因子 23 與 礦物質代謝：病例對照研究 CHIA-HUNG LIN 林家宏 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu branch, Biomedical Park Hospital, Hsin-Chu, Taiwan 台大新竹分院生醫醫院竹北院區 內科部代謝內分泌科
Fibroblast growth factor 23 (FGF23) is involved in the mineral homeostasis, especially the regulation of serum phosphorus. Graves’ disease (GD) is associated with accelerated bone turnover, hyperphosphatemia, and elevated serum FGF23. Evidence suggested that serum FGF23 decreased after a 3-month treatment of GD. However, it remains unclear whether serum FGF23, serum phosphorus, and other markers of mineral metabolism will be normalized after euthyroid status achieved. A total of 62 patients with euthyroid GD and 62 healthy control subjects were enrolled, and the median duration of euthyroid status was 1.6 years. Endocrine profiles including thyroid function test, autoantibodies, serum FGF23, and bone turnover markers were obtained and compared between the two groups. Euthyroid GD patients had significantly higher serum FGF23 and phosphorus, and lower 25-hydroxyvitamin D (25(OH)D) and intact parathyroid hormone (iPTH) levels as compared with the control group. Serum FGF23 was significantly and negatively correlated with phosphorus level after adjusted for age, gender, calcium, iPTH, and 25(OH)D in the euthyroid GD group. Serum phosphorus and FGF23 levels remain higher in GD patients even after euthyroid status has been achieved for a median of 1.6 years. Serum FGF23 was negatively correlated with serum phosphorus in euthyroid GD patients. Underlying mechanisms warrant further investigations. 125
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
AR-1
THE MOLECULAR MECHANISMS ON PROLIFERATION, INSULIN SECRETORY FUNCTION AND SURVIVAL OF ISLET β CELLS
胰島貝他細胞增殖、分泌胰島素功能與細胞存活的分子機制 TIEN-JYUN CHANG 張恬君 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 台大醫院內科部代謝內分泌科
Purpose These studies explored the molecular mechanisms on proliferation, insulin secretory function and survival of islet β cells. Method Male Sprague-Dawley rats were used in these experiments. In situ rat pancreatic perfusion with an open system was performed at 37°C. Rat pancreas islet cells were isolated from male Sprague–Dawley rats. MIN6 cells or RINm5F cells were used in vitro studies. Mitochondrial function and oxidative stress were measured. Western blot for target proteins were performed. Result Rosiglitazone (RSG), an insulin sensitizer can enhance glucose-stimulated insulin secretory capacity of β cells through PI-3 kinase pathway in Sprague-Dawley rats. Furthermore, we has found RSG potentiates insulin secretion via PI-3 kinase dependent activation of AMP-dependent protein kinase (AMPK) and closure of KATP channel, then elevates the membrane potential of β cells, ultimately leads to stimulate insulin secretion in a mouse insulinoma cell line, MIN6 and rat primary islets. In order to explore the molecular mechanism related to beta cell neogenesis and/or proliferation, we created a beta-cell INGAP transgenic mice (IP-INGAP), and the transgenic mice showed enhanced normalization of blood glucose during IPGTT. Furthermore, IP-INGAP mice had a significant delay in development of hyperglycemia following administration of streptozotocin. A decrease in
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Abstract islet expression of the NADPH oxidase, NOX1, in both basal state and in response to proinflammatory cytokine stimulation were found. Methylglyoxal (MG) and 4-hydroxy-2nonenal (4-HNE) lead to glucolipotoxicity of β cells. GLP-1 receptor agonist (GLP-1 RA) and aldehyde dehydrogenase 2 (ALDH2) activator ameliorated glucolipotoxicity on β cell function and survival via improving mitochondrial function. Conclusion Through elucidating the molecular mechanisms of beta cell proliferation, function and survival, we can find more potential drug targets on treating diabetes.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
AP-1
EFFECT OF A NOVEL MACROPHAGE-REGULATING DRUG ON WOUND HEALING IN PATIENTS WITH DIABETIC FOOT ULCERS: A RANDOMIZED CLINICAL TRIAL
全新巨噬細胞調節藥物治療糖尿病傷口癒合的效應：隨機臨床試驗 1,2
YY HUANG, 3CW LIN, 4NC CHENG , 5SM CAZZELL, 6HH CHEN, 7KF HUANG, 8 KY TUNG, 9HL HUANG, 10PY LIN, 11,12CK PERNG, 13BM SHI, 14C LIU, 15YJ MA, 16 YM CAO, 17YB LI, 18YM XUE, 19L YAN, 20Q LI, 21,22,23,24G NING, 25,26SC CHANG* 1,2
黃禹堯、3 林晴雯、4 鄭乃禎 , 5SM Cazzell、6 陳信翰、7 黃國峯、8 董光義、9 黃玄禮、 10 林寶源、11,12 彭成康、13 施畢旻、14 劉昌、15 馬瑜瑾、16 曹燁民、17 李延兵、18 薛耀明、 19 嚴勵、20 李秋、21,22,23,24 寧光、25,26 張舜程 * 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.; 2Department of Medical Nutritional Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.; 3Oneness Biotech Company Limited, Taipei, Taiwan.; 4Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.; 5Limb Preservation Platform Inc, Fresno, California.; 6Plastic and Reconstruction Surgery, China Medical University Hospital, Taichung, Taiwan.; 7Plastic Surgery Center, Chi-Mei Medical Center, Tainan, Taiwan.; 8Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan.; 9Division of Cardiology, Buddhist Tzu Chi General Hospital, Taipei, Taiwan.; 10Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.; 11Division of Plastic and Reconstructive Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; 12Department of Surgery, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.; 13Department of Endocrinology, The First Affiliated Hospital of Soochow University, Jiangsu, China.; 14Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangsu University, Jiangsu, China.; 15 Department of Endocrinology, The First Affiliated Hospital of Henan Science and Technology University, Henan, China.; 16Department of Vascular Anomalies, Shanghai TCM (Traditional Chinese Medicine)Integrated Hospital, Shanghai, China.; 17Department of Endocrinology, The First Affiliated Hospital of Sun Yatsen University, Guangdong, China.; 18Department of Endocrinology, Nanfang Hospital of Southern Medical University, Guangdong, China.; 19Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yatsen University, Guangdong, China.; 20Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China.; 21Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Shanghai, China.; 22Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai, China.; 23Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai, China.; 24Shanghai Jiao Tong University School of Medicine, Shanghai, China.; 25Division of Plastic Surgery, Department of Surgery, Integrated Burn and Wound Care Center, Taipei Medica University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.; 26Division of Plastic Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 林口長庚紀念醫院內分泌暨新陳代謝科及另 25 機關單位 ( 因版面詳細請見英文 )
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Abstract Purpose Delayed healing of diabetic foot ulcers (DFUs) is known to be caused by dysregulated M1/M2-type macrophages, and restoring the balance between these macrophage types plays a critical role in healing. However, drugs used to regulate M1/M2 macrophages have not yet been studied in large randomized clinical trials. The object of this study is to compare the topical application of ON101 cream with use of an absorbent dressing (Hydrofiber; ConvaTec Ltd) when treating DFUs. Method This multicenter, evaluator-blinded, phase 3 randomized clinical trial was performed in 21 clinical and medical centers across the US, China, and Taiwan from November 23, 2012, to May 11, 2020. Eligible patients with debrided DFUs of 1 to 25 cm2 present for at least 4 weeks and with Wagner grade 1 or 2 were randomized 1:1 to receive ON101 or control absorbent dressings. Twice-daily applications of ON101 or a absorbent dressing changed once daily or 2 to 3 times a week for 16 weeks, with a 12-week follow-up. The primary outcome was the incidence of complete healing, defined as complete reepithelialization at 2 consecutive visits during the treatment period assessed on the full-analysis set (FAS) of all participants with postrandomization data collected. Safety outcomes included assessment of the incidences of adverse events, clinical laboratory values, and vital signs. Result In the FAS, 236 eligible patients (175 men [74.2%]; mean [SD] age, 57.0 [10.9] years; mean [SD] glycated hemoglobin level, 8.1% [1.6%]) with DFUs classified as Wagner grade 1 or 2 (mean [SD] ulcer area, 4.8 [4.4] cm2) were randomized to receive either the ON101 cream (n = 122) or the absorbent dressing (n = 114) for as long as 16 weeks. The incidence of complete healing in the FAS included 74 patients (60.7%) in the ON101 group and 40 (35.1%) in the comparator group during the 16-week treatment period (difference, 25.6 percentage points; odds ratio, 2.84; 95% CI, 1.66-4.84; P < .001). A total of 7 (5.7%) treatment-emergent adverse events occurred in the ON101 group vs 5 (4.4%) in the comparator group. No treatment-related serious adverse events occurred in the ON101 group vs 1 (0.9%) in the comparator group. Conclusion In this multicenter randomized clinical trial, ON101 exhibited better healing efficacy than absorbent dressing alone in the treatment of DFUs and showed consistent efficacy among all patients, including those with DFU-related risk factors (glycated hemoglobin level, ≥9%; ulcer area, >5 cm2; and DFU duration, ≥6 months). 129
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
AP-2
THERAPEUTIC INHIBITION OF POLO-LIKE KINASES IN ANAPLASTIC THYROID CANCER
抑制 POLO-LIKE KINASES 治療甲狀腺未分化癌 1
SHU-FU LIN, 2CHUN-NAN YEH, 3YU-TUNG HUANG, 4TING-CHAO CHOU, 5 RICHARD J. WONG 1
林樹福、2 葉俊男、3 黃昱曈、4 周廷潮、5 RICHARD J. WONG
1
Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan. Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 3Center for Big Data Analytics and Statistics,Chang Gung Memorial Hospital, Taoyuan, Taiwan. 4Laboratory of Preclinical Pharmacology Core, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 5Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 2
1 3
新北市立土城醫院 ( 委託長庚醫療財團法人興建經營 ) 新陳代謝科；林口長庚紀念醫院， 2 一般外科， 巨量資料及統計中心；Memorial Sloan-Kettering Cancer Center， 4 臨床前藥理學核心實驗室， 5 外科部
Purpose Polo-like kinases (PLKs) are potent regulators of cell proliferation and cell survival. Polo-like kinases are potential targets in the treatment of anaplastic thyroid cancer (ATC), a rare but deadly disease. Method The therapeutic effects of volasertib, a PLK inhibitor, was evaluated for the treatment of ATC either alone or in combination with sorafenib. Result Volasertib decreased cell viability in three ATC cell lines (8505C, 8305C, and KAT18) in a dose-dependent manner. Volasertib caused ATC cells to accumulate in G2/M phase, activated caspase-3 activity, and induced apoptosis. Combination therapy using volasertib and sorafenib in ATC cells showed mostly synergistic effects. In vivo studies revealed that combination therapy of volasertib and sorafenib was effective in the treatment of 8505C xenografts. Single-agent volasertib treatment was sufficient to retard 8305C tumor growth. No substantial morbidity was observed in animals that received either single-agent or combination treatment Conclusion These preclinical findings suggest that volasertib could be an effective drug in treating ATC. 130
Abstract AP-3
REDUCED EXPRESSION OF UROKINASE PLASMINOGEN ACTIVATOR IN BROWN ADIPOSE TISSUE OF OBESE MICE MODELS
肥胖小鼠中棕色脂肪組織降低尿激酶纖溶酶原激活酶之表現 1,2
C-Z WU, 3L-C CHANG, 4,5C-W CHENG, 1,6T-C FANG, 4,7Y-F LIN , 8D PEI , 9J-S CHEN
1,2
吳忠擇、3 張立乾、4,5 鄭朝文、1,6 方德昭、4,7 林裕峯、8 裴馰、9 陳金順
1
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, R.O.C; 3 School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, R.O.C; 4 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C; 5 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C; 6 Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C; 7 Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, R.O.C.; 8 Division of Endocrinology and Metabolism, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan, R.O.C.; 9 Deputy Superintendent, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, R.O.C. 臺北醫學大學醫學院， 1 醫學系內科學科、 4 臨床醫學研究所；衛生福利部雙和醫院， 2 新陳代謝科、 7 腎 臟內科； 6 臺北醫學大學附設醫院腎臟內科；國防醫學院， 3 藥學系、 5 醫學科學研究所； 8 天主教輔仁大 學附設醫院新陳代謝科； 9 高雄榮民總醫院副院長
Purpose In recent decades, the obesity epidemic has resulted in increasing morbidities and mortality. Dysfunction of adipose tissue has been widely noted to be associated with hyperglycemia, dyslipidemia, and macrophage infiltration in peri-visceral fat. Meanwhile, hypoxia and fibrosis of adipose tissue, abundant collagen, and extracellular matrix deposits contributing to inflammation and the infiltration of macrophages are regarded as important pathogenic mechanisms. Here, using obese mice models, we investigated the relationship among urokinase plasminogen activator (uPA), metabolic disorders, glomerular filtration, and adipose tissues. Method We fed two groups of each of C57BL/6J, Th1 prone strain, and BALB/c, Th2 prone strain, male mice with a chow diet (CD) and a high fat diet (HFD, 45% fat), respectively. Of the two HFD groups, we euthenized half of each group when body weight reached 30 g (BW30), and the other half, at 40 g (BW40). We harvested blood, urine and adipose tissues 131
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for enzyme-linked immunosorbent assay, immunohistochemical stain and Western blot to evaluate the effects of obesity. Result In both mice models, mouse insulin resistance and body weight increased with duration of feeding a HFD when compared with those in the groups on a CD. C57BL/6J mice were prone to obesity, insulin resistance, glomerular hyperfiltration, and dyslipidemia on a HFD. BALB/c mice were prone to obesity, insulin resistance, hyperglycemia. and dyslipidemia. In both HFD C57BL/6J and BALB/c mice, levels of serum uPA initially increased significantly in the BW30 mice, and then the increment decreased in the BW40 mice. Glomerular filtration declined in both HFD groups. In immunohistochemical stain and Western blot of uPA on different adipose tissues, in the HFD mice, expression of uPA significantly decreased in brown adipose tissue (BAT), but not in white adipose tissue (WAT), when compared with that in the CD group. Conclusion The results suggest a decline in the expression of uPA in BAT in obese mice models as the serum uPA increased. It is possible to be associated with BAT fibrosis and dysfunction which may need further study.
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Abstract AP-4
HIGH-MOLECULAR-WEIGHT HYALURONIC ACID INHIBITS IL1β-INDUCED SYNOVIAL INFLAMMATION AND MACROPHAGE POLARIZATION THROUGH THE GRP78-NF-ΚB SIGNALING PATHWAY
高分子量透明質酸經由 GRP78-NF-κB 訊息路徑抑制 IL-1β 誘導 的滑膜炎和巨噬細胞極化 1
CHIEN-HSING LEE , 2CHI-FU CHIANG , 1FENG-CHIH KUO , 1SHENG-CHIANG SU , 1 CHIA-LUEN HUANG , 1JHIH-SYUAN LIU , 1CHIEH-HUA LU , 1CHANG-HSUN HSIEH , 3 CHIH-CHIEN WANG , 4CHIAN-HER LEE AND 3PEI-HUNG SHEN 1
李建興、2 姜季甫、1 郭俸志、1 蘇聖強、1 黃嘉崙、1 劉智軒、1 呂介華、 1 謝昌勳、 3 王誌謙、 4 李建和、3 沈培弘 1
National Defense Medical Center, Division of Endocrinology and Metabolism, Tri-Service General Hospital,Taipei 114, Taiwan; doc10383@gmail.com (C.-H.L.); shoummie@hotmail.com (F.-C.K.);doc10504@ gmail.com (S.-C.S.); gallon828@hotmail.com (C.-L.H.); ajleonn21@hotmail.com.tw (J.-S.L.); undeca2001@ gmail.com (C.-H.L.); 10324@yahoo.com.tw (C.-H.H.) 2 National Defense Medical Center, School of Dentistry, Taipei 114, Taiwan; dofugood1205@outlook.com 3 National Defense Medical Center, Department of Orthopedics, Tri-Service General Hospital,Taipei 114, Taiwan; tsghcc@gmail.com 4 Department of Orthopedics, Taipei Medical University, Taipei 110, Taiwan; chianherlee@yahoo.com.tw 1 4
國防醫學院 三軍總醫院 內分泌新陳代謝科、2 國防醫學院 牙醫學系、3 國防醫學院 三軍總醫院 骨科部、 台北醫學大學附設醫院 骨科部
Purpose Recent evidence has suggested that synovial inflammation and macrophage polarization were involved in the pathogenesis of osteoarthritis (OA). Additionally, high-molecular-weight hyaluronic acid (HMW-HA) was often used clinically to treat OA. GRP78, an endoplasmic reticulum (ER) stress chaperone, was suggested to contribute to the hyperplasia of synovial cells in OA. However, it was still unclear whether HMW-HA affected macrophage polarization through GRP78. Therefore, we aimed to identify the effect of HMW-HA in primary synovial cells and macrophage polarization and to investigate the role of GRP78 signaling. Method We used IL-1β to treat primary synoviocytes to mimic OA, and then treated them with HMW-HA. We also collected conditioned medium (CM) to culture THP-1 macrophages and 133
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examine the changes in the phenotype. Result IL-1β increased the expression of GRP78, NF-κB (p65 phosphorylation), IL-6, and PGE2 in primary synoviocytes, accompanied by an increased macrophage M1/M2 polarization. GRP78 knockdown significantly reversed the expression of IL-1β-induced GRP78-related downstream molecules and macrophage polarization. HMW-HA with GRP78 knockdown had additive effects in an IL-1β culture. Finally, the synovial fluid from OA patients revealed significantly decreased IL-6 and PGE2 levels after the HMW-HA treatment. Conclusion Our study elucidated a new form of signal transduction for HMW-HA mediated protection against synovial inflammation and macrophage polarization and highlighted the involvement of the GRP78-NF-κB signaling pathway.
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Abstract OE-1
A CLINICOPATHOLOGICAL ANALYSIS OF ASIAN PATIENTS WITH ADRENOCORTICAL CARCINOMA: A SINGLE-CENTER EXPERIENCE 1
WEN-HSUAN TSAI, 2SHUEN-HAN DAI, 1CHUN-CHUAN LEE, 1MING-NAN CHIEN, 1 YI-HONG ZENG 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (ROC); 2 Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan (ROC)
Background: Currently, there is limited information regarding the immunohistochemistry stain and its prognostic role in adrenocortical carcinoma (ACC), and few studies focus on Asian patients. Our study aims to identify the correlation between immunohistochemistry staining and the prognosis of ACC in Asian patients. Methods: We searched the database of a single center in Taiwan for cases with a pathological diagnosis of ACC in the past 25 years. We collected patient data on age, sex, initial presentation, staging, metastatic site, and survival duration. Immunohistochemical studies using antibodies to CDK4, ATRX, beta catenin, Ki-67, SSTR2, and p53 were performed. Survival analysis was performed using the log-rank test. Results: Fourteen patients were identified, and the median age was 49.5 (range 1-70) years. There were eight male and six female patients. Four patients presented with Cushing’s syndrome and half were diagnosed with stage IV ACC at presentation. The most frequent metastatic site was in the liver, followed by the lung and peritoneum. Only three patients survived (21%). The mean survival time was 37.1 (range 0.67-244) months. SSTR2 was not associated with survival, and an SSTR2 expression score >50 predicted mortality (log-rank test: P=0.009). Beta-catenin, CDK4, P53, and ATRX were not relevant to patient mortality. Ki-67 was significantly relevant to survival with a cut-off value of 50% (log-rank test: P=0.017). Conclusions: SSTR2 expression score >50 and Ki-67 >50% were found to be prognostic factors of ACC in the present study. SSTR intensity may therefore be responsible for the prognosis of ACC. 135
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OE-2
URINARY EXOSOMAL BIOMARKERS ANGIOPOIETIN-1 AND TIMP (TISSUE INHIBITORS OF METALLOPROTEINASES) FOR PROGNOSTIC PREDICTING IN WELL-DIFFERENTIATED THYROID CANCER 1
CHIH-YUAN WANG, 1SHIANG-RONG SHIH, 2JUEN-YUAN CHEN, 1PEI-JIE HUANG
1
Department of Internal Medicine , National Taiwan University Hospital,Taipei,Taiwan; 2Department of Surgical department , National Taiwan University Hospital ,Taipei,Taiwan
Background: Thyroid cancer could be divided into well-differentiated and poorlydifferentiated. Usually, the prognosis of well-differentiated thyroid cancer, including papillary and follicular ones, will be very good if such patients could receive complete therapeutic treatment. The survival period will be expected more than two or three decades. Therefore, we might need newer biomarkers other than investigation of serum thyroglobulin. Generally, patients of post-ablative arrangements with surgical intervention and radioactive iodine should withdrawal of thyroid hormone replacement or receiving expensive recombinant human TSH before checking up serum thyroglobulin. The nano-level exosomal particles from human body fluid will provide delicate and molecular messages for various diseases, especially in cancers. Such information will be transmitted via DNA, RNA and peptides. Methods: We enrolled twenty-one patients with well-differentiated thyroid cancer since 2018. All patients received non-invasive investigation of urinary exosomal (UEx) peptides before operation, immediately after operation, post-operative 3, 6 and 12 months. Fresh human urinary sample is collected for exosome precipitation. Modified sequencing-grade trypsin will be added to samples, and digestion will be carried out. The urine analysis of the samples will performed with acquisition methods containing three verified ion-pair transitions per target peptide. Results: We found that UEx Angiopoietin-1 (aOR: 3.09, 95% CI: 0.99-9.60, p=0.052) and UEx TIMP (tissue inhibitors of metalloproteinases) (aOR: 2.24, 95% CI: 0.97-5.15, p=0.058) have borderline significant positive effects on patients with lymph nodes metastasis after adjusting for I-131 treatment (Yes/ No) correction. Conclusions: The UEx Angiopoietin-1 and TIMP suggest their potential roles in predicting progression of thyroid cancer and probable prognosis. 136
Abstract OE-3
OUTCOMES OF PATIENTS DEVELOPED METASTATIC DIFFERENTIATED THYROID CANCER AFTER COMPLETE REMISSION 1
CHIA-JUNG HSU, 1FENG-HSUAN LIU, 1KUN-YO LAI, 2YU-LING LU
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; 2 Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
Background To evaluate the outcomes in differentiated thyroid cancer (DTC) patients who had achieved complete remission initially followed by developed metastatic disease. Methods DTC patients registered in Chang Gung Memorial Hospital thyroid cancer dataset between January 1979 and December 2019 were assessed. Patients who achieved complete remission of DTC subsequently developed metastatic disease were included for analysis. The definitions of complete remission were undetected thyroglobulin level and negative neck ultrasound. Metastatic DTC was diagnosed using radioiodine scan, computed tomography, positron emission tomography and histological exam. Results Fourteen DTC patients who had initial complete remission followed by developing metastatic disease were identified in this database, including 6 males and 8 females with median age of 49.8 years old (IQR, 39.9-53.7) at diagnosis. Nine (64%) patients had papillary cancer, four (29%) had follicular cancer and one (7%) had Hürthle cell cancer. Most patients (13/14) had stage I disease at diagnosis. The median period of disease-free survival was 12.0 years (IQR, 8.2-16.8). The sites of metastasis were lung (71%), bone (7%), mediastinum (7%) and multiple sites (14%). During a median follow-up of 18.3 years (IQR, 14.8-23.8), 2 patients died from thyroid cancer. The 5- and 10-year cancer specific survival rates after recurrence were 92% and 74%, respectively. Statistical analysis using Fisher’s exact test revealed multiple sites of metastasis was associated with increased risk of mortality compared to single metastatic site (p=0.022), while gender, histologic type, age at diagnosis, age at recurrence, and cumulative dose of radioiodine were not. 137
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Conclusions Patients with DTC in remission can develop metastatic disease during follow-up. Multiple sites of metastasis were associated with worse survival outcome.
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Abstract OE-4
REAL-WORLD EFFICACY AND SAFETY OF LENVATINIB IN THYROID CANCER PATIENTS FROM TAIWAN 1
YA-CHU CHANG, 1I-WEN CHEN, 1MIAW-JENE LIOU, 1SZU-TAH CHEN, 2CHIAO-EN WU, 3WEN-HUI CHAN, 1WEI-HUNG HUI
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; 2 Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; 3 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
Background: The aim of this study is to describe our clinical experience with tyrosine kinase inhibitors and to evaluate their efficacy and tolerability in patients with thyroid cancer. We conducted a study to show the real-world experience of lenvatinib in Taiwan. Methods: We retrospectively collected the clinical data of the thyroid carcinoma patients who received lenvatinib treatment in Linkou Chang-Gung Memorial Hospital by chart review from May 1, 2016, to December 31, 2020, and follow up until December 31, 2021. The primary aim was to assess the response rate (defined as the best objective response [complete or partial]) and progression-free survival (PFS). Secondary end-points include overall survival (OS) and toxicity data. Results: From May 2016 to December 2020, 53 patients were treated in Linkou Chang-Gung Memorial Hospital. Two of the patients received as neoadjuvant therapy and three of the patients were unresectable thyroid carcinoma. Forty six (86.8%) patients received radio-active iodine therapy and twenty eight (52.8%) patients had received sorafenib therapy previously. Lenvatinib was started at 24 mg in 13 subjects (24.5%). Overall, progression-free survival was 29.4 months and overall survival was 36.9 months. Partial response and stable disease were observed in 22.6% and in 43.4% of subjects, respectively; disease progression was recorded in 26.4% of patients. Lenvatinib was associated with a median time to objective response of 3.1 months (95% CI, 0.0 to 7.2). Drug-related side-effects were common; the most common were hypertension (47.2%) and proteinuria (45.3%). 139
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Conclusions: Lenvatinib is active and safe in unselected and progressive thyroid cancer patients in reallife setting.
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Abstract OE-5
IMPACT OF EXTRANODAL EXTENSION ON TREATMENT RESPONSE IN DIFFERENTIATED THYROID CANCER FROM A MEDICAL CENTER IN SOUTH TAIWAN 1
JIA-RUEI TSI, 1CHEN-KAI CHOU
1
Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
INTRODUCTION: Currently, ATA risk-stratification system is used to evaluate the reccurent risk of differentiated thyroid cancer. The Lymph node is evaluated according the size and number in the ATA risk-stratification system. Kim, Hye In et al. incorporate extranodal extension(ENE) into the current system to predict recurrence of thyroid cancer patients, the result demonstrate extranodal extension in low volume LN metastasis reveals intermediate risk of recurrence. We retrospectively review our differentiated thyroid cancer patient and conclude the ratio of the treatment response in patient has extranodal extension. METHOD: From 2013 to 2017, total of 976 DTC cases received thyroid cancer therapy in Kaohsiung Chang Gung Memorial Hospital were included in this study. We analyzed sequential follow up treatment response defined by America Thyroid Association guideline in the DTC patients whether the extranodal extension affects the excellent treatment response rate in stage I and II patients. We evaluate the outcome with treatment response. RESULT: We include the thyroid cancer between 2013-2017 and exclude the anaplastic and medullary thyroid cancer and patient without intact pathology report and loss to follow up. 976 patients were included. Lymph node invasion was noted in 169 patients. About 17% lymph node invasion in our study population and 71% patients has ENE. We divided patients with lymph node invasion into stage I and stage II according TNM stage and age. Generally, excellent treatment response rate of ENE(+) population is 61% and excellent treatment response rate of ENE(-) population is 85%. The excellent treatment response rate in population of lymph node invasion , ENE(+) and 141
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in TNM stage 1 is 62% and the ENE(-) is about 84%. The excellent treatment response rate in population of lymph node invasion , ENE(+) and in TNM stage 2 is 60% and the ENE(-) is about 69%. CONCLUSION: Population with ENE has lower excellent treatment response rate. Our analysis demonstrates patients ENE is an import risk factor to affect excellent treatment response rate in stage 1 and 2 at the same time.
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Abstract OE-6
LONG NON-CODING RNA HOTAIR REGULATES CELLULAR MALIGNANCY AND EPIGENETICALLY SUPPRESSES DLX1 IN PAPILLARY THYROID CANCER 1*
FENG-CHIH KUO, 2YU-TING WANG, 1,2*CHIEN-HSING LEE
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.; 2Department and Graduate Institute of Life Biochemistry, National Defense Medical Center, Taipei, Taiwan.
Background: Papillary thyroid cancer (PTC) is the most common endocrine malignancy with a fast-growing incidence in recent decades. HOTAIR as a long non-coding RNA has been shown to be highly expressed in papillary thyroid cancer tissues and correlated with pathological stages and disease progression. However, there is only a limited understanding of its functional roles and downstream regulatory mechanisms in papillary thyroid cancer cells. Methods: We applied two well-characterized papillary thyroid cancer cell lines (MDA-T32 and MDA-T41) to investigate the phenotypic influence after gain and loss of HOTAIR. The Cancer Genome Atlas (TCGA) database were further utilised to select candidate genes possibly regulated by HOTAIR with validation in the cellular system and immunohistochemical (IHC) staining of PTC tissues. Results: We observed HOTAIR was highly expressed in MDA-T32 cells but presents low levels in MDA-T41. HOTAIR knockdown in high HOTAIR-expressed MDA-T32 cells significantly suppressed cell proliferation, migration, colony formation with cell cycle arrest at G1 phase. On the contrary, HOTAIR overexpression in low HOTAIR-expressed MDA-T41 cells dramatically enhanced cell proliferation, migration, colony formation with cell cycle driven toward S and G2/M phases. Expectedly, corresponding changes of PTEN/ p-AKT proteins were noted after regulating HOTAIR expression, in line with previous findings that PTEN as a HOTAIR suppressed gene. To explore novel HOTAIR downstream mechanisms, we analysed TCGA transcriptome in PTCs and found DLX1 negatively correlated to HOTAIR, and its higher expression associated with better progression free survival. We further validated DLX1 gene was epigenetically suppressed by HOTAIR via performing chromatin immunoprecipitation. Moreover, the IHC stains for DLX1 protein were 143
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considerably decreased from normal thyroid tissues to stage III PTC tissues, indicating DLX1 as a HOTAIR suppressed gene might serve as a novel biomarker to evaluate the PTC disease progression. Conclusions: Our study pointed out that HOTAIR is a key regulator of cellular malignancy and its epigenetic suppression on DLX1 might contribute to the advanced stages of PTCs.
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Abstract OD-1
FIBROBLAST GROWTH FACTOR 21 LEVELS EXHIBIT THE ASSOCIATION WITH RENAL OUTCOMES IN SUBJECTS WITH TYPE 2 DIABETES MELLITUS 1,2
LI-HSIN CHANG, 3,4 LIANG-YU LIN
1
Division of Endocrinology and Metabolism, Department of Medicine, Yeezen General Hospital, Taoyuan, Taiwan; 2Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan; 3Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 4Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
Background: Associations between albuminuria and renal outcomes are inconsistent in patients with type 2 diabetes (T2D). Fibroblast growth factor 21 (FGF-21) is involved in poor renal outcomes among T2D patients with high renal risk. This study aimed to examine the association of FGF-21 and renal outcomes in ordinary Chinese cohort with T2D. Methods: Three hundred and twelve Chinese T2D patients were enrolled in a prospective observational study which excluded individuals with estimated glomerular filtration rates (eGFR) 30% decline in eGFR and worsening albuminuria from consecutive tests of blood/ urine during a 3.5-year follow-up. Results: Sixty six renal events occurred and higher FGF-21 levels were associated with impaired renal outcomes. FGF-21 levels of ≥ 1.40 pg/dL yielded the most sensitivity and specific predictions of renal outcomes according to the receiver operating curve (area under the curve 0.67, p< 0.001; sensitivity 76.2% and specificity 53.3%). Renal events occurred more frequently in subjects with FGF-21 ≥ 1.40 pg/dL than in others (FGF-21 < 1.40 pg/dL; 30% vs. 10%, p<0.001 by log-rank test). The association between FGF-21 ≥ 1.40 pg/dL and renal outcomes remained significant after adjustment for relevant covariates (adjusted hazard ratio 2.28, 95% confidence interval 1.23-4.24, p=0.009) and consistent across subgroups stratified by age, sex, blood pressure, eGFR, albuminuria, and the treatment with use of reninangiotensin system inhibitors.
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Conclusions: Increased FGF-21 levels were associated with renal outcomes in Chinese T2D subjects, making FGF-21 a potential biomarker in diabetic kidney disease.
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Abstract OD-2
COST-EFFECTIVENESS OF THE MODIFIED NHI REIMBURSEMENT CRITERIA ON THE PREVENTION OF CARDIOVASCULAR DISEASE: USING DPP-4/SGLT2 INHIBITOR FIXED-DOSE COMBINATION THERAPY AS AN EXAMPLE 1
CHIH-YAO HSU, 2ELISE CHIA-HUI TAN, 3HUNG-YUAN LI, 4FEI-YUAN HSIAO, 5 MING-CHIN YANG 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; 2National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan; 3Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 4Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; 5Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
Background: In Taiwan, reimbursement of fixed-dose combination (FDC) products containing dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter-2 (SGLT2) inhibitors had been approved to treat people with type 2 diabetes and glycated hemoglobin ≥ 8.5% before May 2020. In May 2020, this regulation was modified to treat patients with glycated hemoglobin > 7.5%. The present study sought to evaluate the costeffectiveness of SGLT2 inhibitor/DPP-4 inhibitor fixed-dose combination therapy for type 2 diabetes mellitus before and after the implementation of the modified reimbursement regulation. Methods: A Markov model was developed to simulate the costs and health outcomes of patients receiving SGLT2 inhibitor/DPP-4 inhibitor FDC products with glycated hemoglobin levels > 7.5% (early use group) compared with those receiving FDC products with glycated hemoglobin levels ≥ 8.5% (delayed use group) over a lifetime horizon. Transition probabilities, costs, and health state utility values were obtained from published sources and the 2010 longitudinal generation tracking database of Taiwan's National Health Insurance. All costs and health outcomes were discounted at a rate of 3% per year. One-way sensitivity analyses, scenario analyses, and probabilistic sensitivity analyses were performed to explore the impact of changes in key data inputs. Results: The early use group resulted in higher total lifetime costs (NT$1,379,697.72 vs 147
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NT$1,355,022.44) while yielding greater quality-adjusted life-years (QALYs) (9.07 vs 8.79) compared with the delayed use group. This translated to an incremental cost-effectiveness ratio of NT$87,096.42 per QALY gained. Sensitivity analyses verified the robustness of the model. Conclusion: Compared to delayed treatment with SGLT2 inhibitor/DPP-4 inhibitor FDC products in patients whose HbA1c levels are ≥ 8.5%, early treatment with FDC products in patients whose HbA1c levels are > 7.5% is likely to be a cost-effective method for the management of patients with type 2 diabetes in a Taiwanese healthcare setting.
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Abstract OD-3
CIRCADIAN MISALIGNMENT ASSOCIATED WITH INCREASED RISK OF MACRO- AND MICRO-VASCULAR COMORBIDITIES IN THE LONG-DURATION TYPE 2 DIABETIC PATIENTS: THE TAIWAN DIABETES REGISTRY (TDR) 1
LI-JU HO, 1CHIEH-HUA LU
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Background: Circadian misalignment has been associated with the development of obesity and type 2 diabetes. Whereas, whether the disturbed circadian rhythm will increase the macro- or micro-vascular complications in patients with long-duration of type 2 diabetes is still uncertain. Methods: Total 1188 type 2 diabetic patients (mean age 65.9 ± 11.4 years; mean diabetes duration 14.0 ± 8.5 years) with long-term follow-up from the Taiwan Diabetes Registry (TDR) were analyzed. Based on the questionnaires and physical examinations performed in the registry, we stratified the severity of circadian misalignments via scoring three factors (sleep duration 9 hours, sit duration ≥ 8 hours and meal numbers ≥ 4 with night snack) and analyzed their associations with the development of macro- and micro-vascular complications using logistic regression analysis. Results: Increased numbers of factors that disturb circadian rhythm were significantly associated with the cardiovascular disease, peripheral arterial occlusion disease (PAOD) and nephropathy (p value of 0.001, 0.014 and 0.037, respectively). After adjusting multiple variables, having more than 2 factors of circadian rhythm misalignment remained statistically significant association with cardiovascular disease and PAOD, with an odds ratio (OR) of 2.09 (95% confidence interval [CI]: 1.18 to 3.69) and 2.68 (95% CI: 1.21 to 5.90), respectively. Among individual factor that disturb circadian rhythm, we revealed that eating more than four meals per day with night snack increased the risk of cardiovascular disease and nephropathy even after multivariable adjustment (OR of 2.60, 95% CI: 1.28 to 5.30, and OR of 2.54, 95% CI: 1.52 to 4.26, respectively). Whereas sit duration for more than 8 hours a day per se increased the incidence of PAOD (OR of 4.32, 95% CI: 2.38 to 7.84). 149
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Conclusions: The circadian misalignment is associated with increased incidences of macro- and micro-vascular comorbidities in the long-duration Taiwanese type 2 diabetic patients.
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Abstract OD-4
ENHANCED MITOCHONDRIAL UNFOLDED PROTEIN RESPONSE AND AGING IN DIABETES 1,4
FENG-CHIH SHEN, 1,4SHAO-WEN WENG, 2,4YU-JIH SU, 3,4YEN-HSIANG CHANG, 1,4 CHING-YI LIN, 1,4PEI-WEN WANG 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2 Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3 Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 4 Center for Mitochondrial Research and Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Background Diabetes mellitus (DM) is a major risk factor for premature age-related conditions related to oxidative damage. Mitochondria are the major sources of reactive oxygen species (ROS), and mitochondrial unfolded protein response (UPRmt) is a protective transcriptional reaction that promotes the stabilization of mitochondrial function. Based on the information, we investigate the interplay between UPRmt and aging in DM and controls. Methods A total of 604 patients with T2DM and 498 controls were included in the study. Anthropometric and biochemistry data and serum biomarkers of UPRmt (HSP10, HSP 60, ATF4, ATF5) and senescence (p21 and p53) determined by immunoassay, and serum thiobarbituric acid reactive substance (TBARS) levels as oxidative stress were analyzed. Results In control groups, age is significantly associated with all UPRmt levels and senescence markers except ATF5. There was a correlation between p53 (senescence) and HSP10 (UPRmt). As compared to control group, patients with T2DM had significantly higher levels of UPRmt, p21, p53 and TBARS, and this difference existed between control group and all subgroups of diabetes with or without complications. Of note, the association between age and biomarkers of UPRmt and senescence observed in the control group was totally lost in T2DM patients. Within the T2DM group, the trend of increasing microvascular complication was correlated with age, duration of disease, Hb1c, eGFR, serum HDL, and HSP60. Overall, there was a good correlation between serum HSP60 and TBARS levels in the T2DM group. Conclusion Our data confirm the enhanced UPRmt and aging in diabetes, and serum HSP60 is a useful biomarker for assessment.
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OD-5
UTILIZATION OF REAL-TIME CONTINUOUS GLUCOSE MONITORING SYSTEM IN T2DM PATIENTS DURING TRANSITION FROM ORAL ANTI-DIABETIC AGENTS TO FIRST INJECTABLE THERAPY 1
CHENG-PIN CHENG, 1CHUN-SING LIN, 1YA-CHUN LI, 1MAN-NI LU, 1TING-YU CHEN, 1 CHUN-JUI HUANG 1
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
Background: Real-time continuous glucose monitoring (rt-CGM) is recommended in patients with T1DM; there is little experience in applying rt-CGM in patients with T2DM during transition from oral antidiabetic drug (OAD) to first injectable therapy. Methods: Four patients without prior experience in rt-CGM who were inadequately controlled on OAD were enrolled in Taipei Veterans General Hospital while planning on shifting to first injectable therapy. Rt-CGM was installed for 7 days while patients were under OAD control (phase I) and again under iGlarLixi after the dosage was titrated to reach a fasting blood glucose less than 130 mg/dL (phase II). In both phases, patients took photos to record the contents of their meals and used Health2Sync to contact our diabetes educators for the advices of dietary and lifestyle modification. Fasting plasma glucose (FPG) and HbA1c at baseline and 3 months after initiation of iGlarLixi, percentage of TIR, and average blood glucose recorded by rt-CGM were collected and analyzed by paired t-test for comparison between the two phases. Results: The first three cases were a 55-year-old female, a 59-year-old female, and a 55-year-old male treated with three kinds of OADs with HbA1c levels of 8.2, 9.9, and 8.4%. Their TIR percentage improved from 52, 78 and 63% to 98, 95, and 97% after substituting OAD with iGlarLixi. The fourth case was a 52-year-old female under four kinds of OADs including one sodium-glucose cotransporter 2 inhibitor who had substantial improvement of TIR from 35% to 87%. Dietary modifications to reduce carbohydrate intake and increase protein 152
Abstract intake were made. Medications were adjusted according to glucose patterns on CGM. To prevent hypoglycemia before lunch and control hyperglycemia after dinner when injecting iGlarLixi before breakfast, the timing of OAD were shifted from before breakfast to before dinner in three cases. The timing for exercise were also changed in two patients. When glucose parameters were compared between baseline and after injectable therapy, statistically significant improvements were found in FPG (p = 0.04), TIR (p < 0.0001) and average blood glucose (p < 0.0001). Conclusions: Rt-CGM provided a comprehensive glucose assessment for precise medication adjustment and personalized lifestyle modification in patients with T2DM under transition from OAD to first injectable therapy.
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OD-6
THE PRELIMINARY SURVEY OF DEMOGRAPHIC DATA OF DMHEART STUDY: THE ROLE OF NT-PROBNP IN TYPE 2 DIABETIC HEART FAILURE 1
CHEN-YU WEN, 1CHIH-YUAN WANG, 1SHIANG-RONG SHIH, 1YIN-CHUEN LAI, 1 WAN-CHEN WU 1
Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital
Background: In recent 10 years, heart failure seemed to be substituted for coronary artery disease as the main causal factor of type 2 diabetic mortality. From the viewpoint of canonical UKPDS study, hyperglycemia played an important role in coronary artery disease, acute coronary syndrome or even myocardial infarction. However, the omitted heart failure in type 2 diabetes emerged its pivotal role since saxagliptin-related SAVOR study till the final EMPA-REG study of empagliflozin. Treatment of heart failure together with renal failure was established to be the cornerstone of essential end-organ protection in type 2 diabetes. Methods: Through the value of biomarker detection, high-risk type 2 diabetes patients who have not previously caused heart disease can be identified, and the epidemiology of highrisk Taiwanese type 2 diabetes with possible heart failure was designed by large-scale cohort research. We use NT-pro BNP to be the biomarker as screening (DM-Heart Study, NTUH: 202104041RIPB) Results: The demographic data in this study enrolled patients aged from 36 to 79 year-old, and 94 women with 97 men were analyzed till January, 2022. (We will enroll more patients till this March report) Interesting, the preliminary data revealed statistically correlation between the levels of proBNP and body height only. Conclusion: We demonstrate this study with the data of preliminary enrollement to remind the importance of long term observation of type 2 diabetes with certain metabolic parameters. The data from real world observation could be more valuable in comparison with analysis from national insurance databse.
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Abstract PE-1
DISCUSSION OF THE RELEVANCE BETWEEN IODINE NUTRITIONAL STATUS AND BRAFV600E MUTATION ON PAPILLARY THYROID CANCER 1
YAN-YU LIN, 2YU-SHAN HSIEH
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 11031, Republic of China (Taiwan); 2School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 11230, Republic of China (Taiwan)
Background: Papillary thyroid carcinoma (PTC) accounts for approximately 85%-90% of all thyroid cancers. BRAFV600E mutation is a highly specific target for papillary thyroid carcinoma (PTC) and may have a reciprocal causative relationship with iodide-metabolizing genes. Methods: We performed a review of studies published in the past 10 years to determine the relationship between iodine intake and BRAFV600E mutation in patients with PTC. We searched the MEDLINE, PubMed, and EMBASE databases for studies published from 2009 to 2020; seven partially matched the selection criteria and were suitable for review, and five passed all selection criteria. We divided the patients into three groups by iodine intake: low (urinary iodine concentration [UIC] <100 μg/L), adequate (UIC 100–200 μg/L), and high iodine intake groups (UIC ≥200 μg/L). Results: Between-group analysis revealed no significant differences in the odds ratio of the prevalence of BRAFV600E mutation between the high and adequate/low iodine intake groups and between the adequate and low iodine intake groups. To further analyzed the results of studies, they exhibited U-shaped curves in the relation of deficient and excessive dietary iodine intake in BRAFV600E mutation. Conclusions: The results might suggest that iodine intake slightly influences the prevalence of BRAFV600E mutation in patients with PTC despite the heterogeneity of studies. Further research should explore potential mechanisms underlying the associations between iodine intake and BRAF mutation in PTC. The systematic review was registered in PROSPERO (CRD42021279462).
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PE-3
A CASE OF THYROTOXICOSIS INDUCED BY COVID-19 VACCINES 1
WEU-LUN WANG, 1KUAN-HUA CHEN, 1YUNG-CHUAN LU, 1HING-CHUNG LAM, 1 PI-JUNG HSIAO, 1YU-HSI KAO, 1HE-JIUN JIANG, 1KUO-BIN TSENG, 1SHU-JU KU, 1 CHEN-TI WANG, 1HIROSHI UENO 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, E-DA Hospital, Taiwan, R.O.C.
Background: SARS-CoV-2 resulted in a worldwide pandemic, several vaccines are available through emergency use authorization (EUA) during this public health emergency. Like other vaccines, COVID-19 vaccines were reported to induce autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome). Cases with autoimmune thyroiditis and subacute thyroiditis were reported. Due to the novelty of COVID-19 vaccines, experience with thyroid diseases induced by ASIA in Taiwan was still limited. Case presentation: We demonstrate the clinical, laboratory data and image findings of a case with thyrotoxicosis after mRNA COVID-19 vaccine (Pfizer-BioNTech®) injection. This patient was sent to our emergency department for palpation and progressive dyspnea one day after vaccination in 2021/10. She denied having a previous record of thyroid disease, nor recent upper respiratory tract infection. Laboratory data revealed decreased TSH and elevated free T4 levels. Her thyroid autoantibodies were elevated as well.Thyroid sonography revealed hypervascularity and heterogeneous texture in the whole thyroid gland. Under the impression of new autoimmune thyroiditis, the patient was treated with methimazole, steroids, and Lugol’s solution. Her symptoms gradually improved as treatment started. She was thus discharged and returned to out-patient clinics regularly for long-term management and follow-up. Conclusions: COVID-19 vaccination can cause thyrotoxicosis through ASIA. Graves’ disease may be induced after vaccination, and the patient requires timely and proper management.
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Abstract PE-4
SUCCESSFUL TREATMENT OF THYROID STORM COMBINED WITH ACQUIRED HEMOPHILIA WITH PLASMAPHERESIS: A CASE REPORT 1
YU-LING LIN
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Feng yuan hospital, ministry of health and wealfare, Taiwan, R.O.C.
Background Patients with autoimmune thyroid disease(AID) are at increased risk of additional autoimmune diseases. Acquired hemophilia is a rare disease characterized by the presence of an autoAb to factor VIII and has been reported rarely in pts with AID. Case presentation Here we report a 45 y/o female who is admitted due to SOB with chest tightness and palpitation. Thyroid storm(BWPS:85) was diagnosed and her condition deteriorated despite medical treatment(propylthiluracil, steroid and lugol’s solution) and developed coagulopathy. Therapeutic plasma exchange(TPE) was given for 3 times. Besides, Lab reported factor VIII deficiency in this pt and acquired hemophilia is diagnosed . After TPE, her condition improved and coagulopathy also remitted. Discussion Traditional therapy for thyroid storm is focused on inhibiting thyroid hormone synthesis and release combin2ed with supportive treatment but not target on the autoimmunity. TPE is a therapeutic option without clear guidelines about the indication. TPE is elective for treatment of thyroid storm as thyroid hormone is almost entirely bound to plasma proteins and TPE can also remove TSH receptor autoAb. Conclusions According to .the American Society for Apheresis 2016 guidelines, treatment of thyroid storm with plasmapheresis is a category III indication meaning that the optimal role of TPE in thyroid storm is not established and the decision to use TPE for this indication should be individualized. Thyroid storm is still a disease with high mortality. Screening for other autoimmune diseases might be indicated if subjects present /c new symptoms. Besides, given the successful treatment seen with TPE, endocrinologists should consider TPE in the treatment course of thyroid storm. 157
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PE-5
NEW STRATEGIES FOR TREATMENT OF THYROTOXIC PERIODICAL PARALYSIS 1
CHE-CHIEH LIAO, 1TZU-YUAN WANG, 1CHING-CHU CHEN, 1CHWEN-TZUEI CHANG, 1 RONG-HSING CHEN, 1WEI-LUN HUANG, 1JUEI-YU TSENG, 1YIN-HUEI CHEN, 1 JIA-YIN GUO, 1YOU-TING LIN, 1YING-YU TENG, 1YI-TING CHIU, 1YUN-CHI LEE, 1 YI-CHING TSAI 1
Division of Endocrinology and Metabolism, Department of internal medicine, China Medical University Hospital, Taichung, Taiwan
Background: Treatment of thyrotoxic periodic paralysis (TPP) includes intravenous or oral potassium supplementation, prevention of the shift of potassium by using nonselective beta-blockade and treatment of the underlying hyperthyroid state. TPP does not recur once a euthyroid state is achieved. However, traditional therapy with antithyroid drugs (ATD) need one to two months’ duration to achieve normal free T4 level. The aim of this study is to describe the efficacy and safety of using similar treatment protocol for thyroid storm in patients with TPP. Methods: Retrospective study on 5 male Taiwanese patients, mean aged 32.8 ± 5.8 years, range 23 to 38 years, diagnosed as having TPP who using similar treatment protocol as treating thyroid storm in China medical university hospital. The follow-up period was range 10 months from 4 years Results: Hypokalemia was noted in all episodes of TPP, with serum potassium levels ranging from 1.5 to 2.0 meq/L (mean 1.78 ± 0.19 meq/L). At initial diagnosis, thyroid function test of the patient showed elevation free T4 or free T3 and suppression TSH. During one week’s treatment, the free T4 decrease to normal range. Then, dose of ATD, lugol’s solution, propranolol and prednisolone were reduced. No recurrent attack of hypokalemic paralysis occurred in any patients. Safety of this treatment was good and none of patients discontinued treatment due to side effects. Conclusions: This study confirms the efficacy and safety by using similar treatment protocol for thyroid 158
Abstract storm in male Taiwanese patients with TPP. This therapy could be new strategies for treatment of thyrotoxic periodical paralysis
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PE-6
PROGNOSIS OF DIFFERENTIATED THYROID CARCINOMA WITH MEDIASTINAL METASTASIS 1
KUN-YO LAI, 2SHU-FU LIN, 1FENG-HSUAN LIU, 2YU-LING LU, 1HSU-CHIA JUNG
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, R.O.C.; 2Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, R.O.C.
Background: The aim of this study is to evaluate the long-term outcomes in differentiated thyroid carcinoma (DTC) patients with mediastinal metastasis. Methods: Patients with metastatic DTC registered in Chang Gung Memorial Hospital thyroid cancer dataset between January 2000 and December 2020 were identified. These patients were grouped into 4 cohorts according to metastatic sites. Disease-specific survival (DSS) was analyzed using Kaplan–Meier (KM) method. P 0.05 for both comparison). Conclusion: DTC patients with mediastinal metastasis had similar DSS as compared with lung metastasis.
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Abstract PE-7
SECONDARY AMENORRHEA WOMAN HAD BREAKTHROUGH BLEEDING FOLLOWING VACCINATION AGAINST COVID-19: A CASE REPORT AND LITERATURE REVIEW 1
ZI-JIAN LIN, 1SHU-YI WANG
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan
Common side effects of coronavirus disease 2019 (COVID-19) vaccines include fever, fatigue, myalgia, and headache. However, menstrual disturbance including changes of volume and menstrual cycle are not listed. Recent study investigates the relationship between COVID-19 vaccination and menstrual cycle disturbances. Many women with regular menstrual cycle may have menstrual disturbance in some situation. However, breakthrough bleeding is uncommon in the amenorrhea patient. Both mRNA and adenovirus vector COVID-19 vaccines are reported with menstrual change, suggesting that it may be subsequent immune response rather than specific component of vaccines. Researches exploring the association and possible mechanisms of vaccine-induced menstrual abnormalities are ongoing. The assumed mechanism of immune response includes acute immune attack, systemic effects on hemostasis and inflammation, and menstrual repair mechanism. In this report, we present a 49-year-old woman with history of panhypopituitarism and secondary amenorrhea for more than 19 years who having vaginal bleeding and dysmenorrhea after administration of COVID-19 vaccine and review current literature.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PE-8
THE ASSOCIATED RISK OF THIONAMIDES AND BREAST CANCER IN WOMEN: A CASE-CONTROL STUDY 1,2
YING-YU TSENG, 3,4HEI-TUNG YIP, 1,2YOU-TING LIN, 1,2WEI-LUN HUANG, 1,2 RONG-HSHING CHEN, 1,4,5CHING-CHU CHEN 1
Department of Medicine, China Medical University, Taichung 40402, Taiwan; 2Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan; 3 Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan; 4College of Medicine, China Medical University, Taichung 40402, Taiwan; 5School of Chinese Medicine, China Medical University, Taichung 40447, Taiwan
Background: An association of breast cancer with thyroid disease and hormone is a long-debated issue. Antithyroid agent is the most commonly used (96–97%) treatment for hyperthyroidism. So we hypothesize that the associated risk of Graves’ disease with breast cancer are attributable to thionamides use. Methods: We selected female newly diagnosed with breast cancer, which was defined by patients with catastrophic Illness card of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 174 and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code C50, between 2005 and 2018 as the case group of this case-control study. The control patients were female without history of breast cancer and breast cancer in situ (ICD-9-CM code: 233.0; ICD-10-CM code D05). The diagnosis date of breast cancer was the index date of case group and a random date between 2005 and 2018 was a index date of the control group. The exclusion criteria was age below 18. One control patient was matched a case patient by propensity score matching according to age, index year, comorbidities and therapy of iodine and estrogen. Results: The association between breast cancer and thioamides drugs. Compared to thioamides non-user, thionamides user had a higher odds to develop breast cancer. The adjusted odds ratio (aOR) was 1.12 (95% confidence interval (CI) = 1.08, 1.17). The association was also significant when looking into the individual component of thionamides. 162
Abstract Conclusion: Review this study, the result show, thioamides drug user will increase breast cancer risk and the time longer use, the risk of breast cancer will increase.
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PE-9
IGG4-RELATED HYPOPHYSITIS PRESENTING AS CENTRAL DIABETES INSIPIDUS: A CASE REPORT 1
TAO-SHEN OU, 2WEI-HSIN WANG, 3HSUAN-WEI LIN, 4TSUNG-HUI WU, 4,5 CHII-MIN HWU 1
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan; 3Section of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan; 4Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 5Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
Background: IgG4-related hypophysitis is a rarely encountered pituitary lesion with an incidence of 0.28–1.08/100,000 patients. It may present with pituitary failure, diabetes insipidus, and elevated IgG4 levels. Case presentation: A 51-year-old gentleman presented to the endocrinology clinic for excessive thirst and large amount of urine for 2 years. There were also progressively decreased spirit, decreased appetite, decreased libido, and heat intolerance. At first, hyperthyroidism was diagnosed in other hospital and methimazole were prescribed. Sella MRI was performed due to persistent polyuria and revealed lymphocytic hypophysitis and loss of the normal bright signal intensity of posterior pituitary lobe. He was referred to the endocrinology clinic in our hospital. IgG4 level was elevated (138.3 mg/dL). Low testosterone level (0.42 ng/mL) was observed while morning cortisol level (5.7 mcg/dL), morning ACTH level (28 pg/mL), prolactin level (11.51 ng/mL), FSH level (1.7 mIU/mL), and LH level (1.25 mIU/mL) were within normal limits. Low TSH level (0.165 uIU/mL), low free T4 level (0.71 ng/dL, under methimazole), elevated antithyroglobulin antibodies (669.04 IU/mL), elevated thyroid peroxidase antibody (708.20 IU/mL), and elevated TSH receptor antibodies (4.86 U/L) were observed. Autoimmune thyroid disease and IgG4-related hypophysitis with central diabetes insipidus were tentatively diagnosed. After admission, low-dose ACTH stimulation test revealed impaired cortisol response. TRH stimulation test showed that TSH and prolactin both failed to rise. Four-hour glucagon stimulation test found that hGH also failed to rise. He received oral prednisolone 164
Abstract 60 mg per day and was discharged with oral prednisolone 40 mg per day. Follow-up IgG4 level decreased to within normal limits (61.2 mg/dL) at 2 months after discharge while daily desmopressin dose was tapered from 0.4 mg per day to 0.1 mg per day at 8 months after discharge. Oral prednisolone dose was also gradually tapered and kept at 10 mg per day. Conclusions: We demonstrated a case of IgG4-related hypophysitis diagnosed by image study, serology, and therapeutic trial. This may serve as an alternative for invasive procedures such as biopsy of the pituitary gland in these patients.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PE-10
PRE-OPERATIVE THERAPEUTIC PLASMA EXCHANGE IN A THYROTOXIC PATIENT WITH METHIMAZOLE-RELATED SEVERE BONE MARROW SUPPRESSION: A CASE REPORT 1
LI-HSIN PAN, 1XIN-NING NG, 1GUAN-YU SU, 1HSIN-YEN CHEN, 1CHIN-SUNG KUO
1
Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
Background: Methimazole may cause severe bone marrow suppression during treatment of thyrotoxicosis. Therapeutic plasma exchange was reported to be used as bridging therapy to definitive ablation therapy. Methods: We report a case of a thyrotoxic patient with methimazole-induced bone marrow suppression underwent pre-operative therapeutic plasma exchange followed by total thyroidectomy. Results: A 28-year-old woman was diagnosed with Graves’ disease and took Methimazole from 2021/04. In 2021/08, the patient had pancytopenia with WBC 2200/uL, ANC 671/uL, hemoglobin level 7.9g/dL. Methimazole was replaced by lithium therapy due to suspicion of methimazole-related pancytopenia. However, flare-up thyrotoxicosis along with intermittent palpitation and exertional dyspnea was noticed. After failure of medical control, she was admitted for total thyroidectomy in 2021/09. We started therapeutic plasma exchange for severe thyrotoxicosis. The thyroid function gradually improved after 18 sessions of plasma exchange with 24U of fresh frozen plasma as replacement fluid in each session. She experienced skin rash, hypocalcemia and hypokalemia relieved by anti-histamine and electrolyte supplement during plasm exchange. Signs and symptoms of thyrotoxicosis improved soon after therapeutic plasma exchange. She underwent total thyroidectomy smoothly in 2021/10. Conclusions: Therapeutic plasma exchange is effective in removing large amount of protein-bound thyroid hormone and circulating autoantibody. It could be considered as a salvage and a bridging therapy if contraindication to standard therapy.
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Abstract PE-11
IODINE CONCENTRATION DETERMINATION IN COMMERCIAL DAIRY MILK AND PLANT-BASED SUBSTITUTES IN NORTHERN TAIWAN 1
TSAI-YING CHANG, 2FAN-FEN WANG, 3CHEN-CHANG YANG, 3YI-LIN LIU, 4 CHUN-JUI HUANG 1
Department of Food Safety and Health Risk Assessment Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan; 3Department of Clinical Toxicology & Occupational Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ; 4Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
Background: Iodine is an essential nutrient for the synthesis of thyroid hormones. However, there is no complete data of iodine content in food in Taiwan. Methods: According to the Food Safety Law, commercial dairy milk is categorized into eight kinds. Seventy-six samples of milk were analyzed for iodine concentration. Additionally, 19 samples of yogurt and 11 samples of plant-based milk substitutes were also examined. The iodine concentrations were measured using inductively coupled plasma mass spectrometry, and accuracy and precision were calibrated by analyzing the iodine content of NIST SRM1549a whole milk powder (Standard Reference Material 1549a). Results: Average iodine levels of whole milk and low-fat milk were 52.6 μg/250ml (range 9.7-86.2) and 65.8 (59.3-79.2) μg/250ml, and of flavored milk and milk drinks 25.0 (21.4-31.7) μg/250ml, and 16.4 (5.9-52.1) μg/250ml, respectively. The iodine concentration in low-fat milk was slightly higher than in whole milk. Some cool milk drinks or extended shelflife milk drinks were emphasized as being nutrient-rich by having add calcium or vitamins. However, the iodine concentration in most of these products was less than 1/3 of that in whole milk. The average iodine level of extended shelf-life milk was 45.4 (41.0-52.2) μg/250ml. Plant-based substitutes contained almost no iodine, with an average of 0.4 (0-2.6) μg/250ml. Conclusions: With a recommended iodine intake of 150 μg/day for adults, consumption of 0.4 L/day of whole milk or low-fat milk could provide half the daily iodine requirement. Thus, milk should be viewed as an important dietary source of iodine nutrition in Taiwan.
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PE-12
ACROMEGALY PRESENTING AS DIABETIC KETOACIDOSIS - A CASE REPORT 1
BO-YU HUANG, 2YE-FONG DU, 2HORNG-YIH OU, 2PEI-YIN CHEN, 2KAI-PI CHENG, 2 CHING-HAN LIN, 3JOU-CHIEN CHEN, 2SHU-HSUAN HUANG 1
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 3Chi-Le Long-term Care Home Service Institute of Calebasia Co., Ltd,Tainan, Taiwan
A 38-year-old woman who was diagnosed with prediabetes in recent year, presented to our emergency department with complaints of progressive dizziness and nausea for a week. She had easily thirsty, nocturia, and body weight loss for 7 kilograms over the last 3 months. Physical exam revealed tachycardia and Kussmaul’s breathing. Laboratory survey revealed diabetic ketoacidosis, with high random glucose (494mg/dl), high HbA1c (15.5%) and dyslipidemia (LDL-C: 328 mg/dL, CHOL: 439mg/dl, HDL-C: 44 mg/dl, TRIG: 418mg/ dl). The initial precipitating factors for diabetic ketoacidosis were obscure, but high daily insulin requirement (2.2U/kg/day) and remarkable insulin resistance (HOMA-IR index: 4.18) persisted during the hospital course, with preserved pancreatic beta cell insulin secretion (C-peptide: 1.80 ng/ml) checked immediately after DKA remission. A detailed clinical examination at ward revealed thick lips and enlarged fingers. Considered as acromegaly, she recalled that she was unable to wear her wedding ring because of enlarged fingers ten years ago, followed by habitual snoring, intermittent headache, unintentional body weight gain, and amenorrhea after her 2nd childbirth five years ago. Pituitary hormonal investigation revealed elevated IGF-1 levels (774.24 ng/ml) with hypogonadotropic hypogonadism (E2: <5.0pg/ml, LH: <0.3mU/ml, FSH: 0.8mU/ml). Contrast-enhanced MRI of the sella showed a pituitary macroadenoma (10x11x11mm) with suprasellar extension. The patient underwent trans-sphenoidal excision of the tumor. Histopathology report was compatible with pituitary adenoma. After the treatment, her glycemic profiles improved largely and her HbA1c returned to 5.7% without any oral antidiabetic drugs half year later. Diabetic ketoacidosis has been described as a rare presentation for acromegaly. Excess of both growth hormone and IGF-1 increases gluconeogenesis and induces insulin resistance in
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Abstract the liver, adipose tissue, and muscle, leading to glucose intolerance. Relative insulin deficiency resulting from excess counter-regulatory hormones, pancreatic beta-cell dysfunction induced by glucose toxicity, and lipolysis may contribute to ketoacidosis in acromegaly. The impaired glucose tolerance usually improved rapidly after biochemical remission. This case illustrated a possible complication that acromegaly being a cause of diabetic ketoacidosis.
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PE-13
A RARE CASE OF MYXEDEMA COMA AFTER UNCONTROLLED SECONDARY HYPOTHYROIDISM 1
CHIA-CHEN HSU, 2HONG-DA LIN
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan, R.O.C.; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.
Introduction: Myxedema coma is an infrequent life-threatening presentation of severe hypothyroidism. It involves many organs and the hallmarks of symptoms are consciousness disturbance and hypothermia. Prompt treatment upon suspicion of this disease, before laboratory data confirmation, is crucial for the survival. Myxedema coma resulting from hypopituitarism is very rare. We used the words ”myxedema coma” and “pituitary”, searching on “PubMed”, only few case reports were published. Here, we present a case of myxedema coma due to pituitary macroadenoma with secondary hypothyroidism. Case report: A 64 year-old male, had past history of hyperlipidemia, pituitary tumor 1.8cm in length with secondary hypothyroidism, without follow up for 15 months; and coronary artery disease post drug-eluting stent for left circumflex artery 4 months ago. He took aspirin 100mg QD and ticagrelor 90mg BID. He was living in nursing home and his daily performance status was independent before admission. He was sent to the emergent department due to shortness of breath, low blood pressure and slower heart rate for 1 day. Stupor was noted and he also fell asleep easily. Other associated symptom included tarry stool. Besides, left knee swelling, redness and pain were mentioned. At triage, his temperature was 35.3 degree Celsius, heart rate 59 beats per minute, respiratory rate 18 breaths per minute, SpO2 98% under nasal cannula 3 L/min, and blood pressure 90/54mmHg. Physical examination showed Glasgow coma scale:E4V4M5, bilateral pretibial region non-pitting edema(Pic.1). Laboratory data revealed normocytic anemia(Hb:8.1g/dL, MCV:85.7), hypotonic hyponatremia(Na:131mmol/L, blood osmolarity:276mOsm/kg), elevated aspartate aminotransferase and alanine aminotransferase 170
Abstract (AST:81U/L, ALT:90U/L), impaired renal function(BUN:68mg/dl, cre:2.33mg/dl), high C-Reactive protein (CRP:20.8mg/dL). Adrenal function and thyroid function were collected for survey of bradycardia and hypotension, which revealed low cortisol(AM cortisol:3.1mg/ dL) with normal adrenocorticotropic hormone(ACTH:27.2pg/mL), low free T4(FT4:0.40ng/ dL) with normal thyroid-stimulating hormone (TSH:2.05uIU/mL), secondary adrenal insufficiency and secondary hypothyroidism were suspected. We also checked other pituitary hormones, the result showed follicle-stimulating hormone(FSH:1.67mIU/mL), luteinizing hormone(LH:1.29mIU/mL), low testosterone(testosterone:<0.1ng/mL), elevated prolactin(prolactin:50.6ng/mL), human growth hormone(hGH:0.25ng/mL), decreased insulinlike growth factor-1(IGF-1:12.19ng/mL)for his age.Blood gas showed respiratory alkalosis and metabolic alkalosis(pH:7.5, PCO2:38.4mmHg, HCO3-:30.2mmol/L). Urine analysis found pyuria (urine wbc:10-19/hpf). Left knee synovial fluid aspiration was performed and demonstrated gouty arthritis(synovial fluid wbc:24530/uL, uric acid:positive). EKG revealed sinus bradycardia, QTc prolong(QTc:548ms), PR prolong(PR interval:205ms). His stool occult blood was positive, thus panendoscopy was done and found gastric ulcer. His clinical symptoms, laboratory and EKG findings, fulfilled the diagnostic scoring system for myxedema coma by Dr. Popoveniuc et al(Endocrine Practice, 2014), which sets a score of 60 or higher as highly suspicious disease, and the score of our case was 90. After hydrocortisone intravenous 100mg loading dose then 50mg every eight hours was given for adrenal insufficiency, and levothyroxine 150ug loading dose then 100ug QD before meal was prescribed for myxedema coma, his condition improved totally. Sella MRI found a intrasellar and suprasellar tumor about 3.2 cm in dimension, with external compression of the optic chiasm and left optic nerve, suspicious tumor invasion into the left cavernous sinus was also noted(Pic. 2.3). Transsphenoidal removal of pituitary adenoma was performed later. Tumor cells were reactive against FSH and synaptophysin antibodies, gonadotroph adenoma was confirmed. Comment: Myxedema coma is the manifestation of severe longstanding hypothyroidism, or poorly controlled hypothyroidism, precipitated by acute events like infection, cold weather, sedative agents, stroke, or gastrointestinal bleeding. In our case, he had past history of pituitary tumor with secondary hypothyroidism, but remained no treatment, causing severe hypothyroidism. His myxedema coma was precipitated by gastrointestinal bleeding and urinary tract infection. Consciousness disturbance and hypothermia is the hallmarks of symptoms, others included hypoventilation, cardiovascular abnormalities, such as bradycardia, decreased cardiac 171
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contractility and hypotension. Early recognition of this disease and initiating treatment even laboratory results is not available yet is important, because of it’s high mortality, up to fifty percent. Stress doses of hydrocortisone should be prescribed prior to thyroxine, for relative adrenal insufficiency, which is commonly seen in myxedema coma, especially myxedema caused by secondary hypothyroidism.
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Abstract PE-14
AN UNUSUAL CASE OF ADRENAL LYMPHOMA PRESENTING WITH AUTONOMOUS CORTISOL SECRETION 1
CHUN-HENG KUO
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
Adrenal lymphoma is a rare disease entity, which may cause adrenal dysfunction, mostly adrenal insufficiency. Here, we report an unusual case of bilateral adrenal lymphoma, who presented with autonomous cortisol secretion. This case is a 54-year-old male patient, who developed poor appetite, fatigue, nocturnal sweats and weight loss of 9 kg in half a year. He sought medical advice at Fu Jen Catholic University Hospital, where bilateral huge adrenal tumors were noted accidentally by an abdominal ultrasonography. A computed tomography (CT) scan revealed bilateral adrenal tumors with right side of 7.3 cm and left of 6.7 cm in the largest dimension. CT-guided biopsy of left adrenal tumor was performed, which confirmed the diagnosis of intravascular large B cell lymphoma. He denied hypertension history, palpitation, headache, pallor, dizziness or fluctuating blood pressure. He didn’t look like Cushingoid appearance (no buffalo hump, moon face, central obesity or purple striae). However, an overnight 1mg dexamethasone suppression test (DST) showed nonsuppressible hypercortisolism with 8 am cortisol levels of 3.77 μg/dL and suppressible 8 am adrenocorticotropic hormone levels of 2.5 pg/mL. We further performed low-dose DST with dexamethasone 0.5 mg q6h given orally for 2 days, which showed still nonsuppressible 8 am cortisol levels of 6.7 μg/dL. Autonomous cortisol secretion was impressed. Meanwhile, the patient developed persistent hypotension with blood pressure around 80/40 mmHg, hyperkalemia (serum K levels of 5.0 mmol/L) and hyponatremia (serum Na levels of 124 mmol/L). Hypoaldosteronism was impressed. Fludrocortisone was administered as mineralocorticoids supplement.
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PE-15
SILENT CORTICOTROPH ADENOMA WITH PITUITARY APOPLEXY: A CASE REPORT 1
GUAN-YU SU, 1,2CHII-MIN HWU, 1GING-SHING WON
1
Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
Background: Pituitary tumors that stain positive for adrenocorticotropic hormone [ACTH] without causing Cushing disease are defined as silent corticotroph adenomas [SCAs]. In comparison of standard nonfunctioning adenomas [NFAs], SCAs usually have more aggressive behavior, and may develop pituitary apoplexy, which need immediate evaluation and treatment. Methods: We reported a male patient who had a silent corticotroph adenoma complicated with pituitary apoplexy in this article. Results: The 79-year-old Taiwanese man, without clinical evidence of Cushing disease, experienced progressive right ptosis, hypotension and general malaise. His laboratory data showed low concentrations of serum ACTH (6.0 pg/mL), serum cortisol (1.3 ug/ dL), thyrotropin (0.116 uIU/mL) and luteining hormone [LH] (<0.5 mIU/mL), supporting the diagnosis of hypopituitarism. The brain magnetic resonance imaging [MRI] revealed enlargement of the pituitary gland with pituitary apoplexy. Intravenous hydrocortisone and oral levothyroxine were prescribed for hemodynamic stabilization and replacement therapy. He underwent endoscopic trans-nasal trans-sphenoidal surgery, and the pathology report revealed a pituitary adenoma with extensively coagulative necrosis and positive stain of ACTH. His symptoms including right ptosis and hypotension improved after surgical intervention and medical treatment. Conclusions: SCAs with pituitary apoplexy may result in acute endocrine dysfunction and neuroophthalmic complications. Appropriate evaluation and management are associated with neuroophthalmic recovery and endocrinological prognosis. 174
Abstract PE-16
PREVALENCE OF THYROID NODULES AND THE RATE OF SUSPICIOUS MALIGNANCY IN PRIMARY PHYSICIAN CLINIC: A RETROSPECTIVE STUDY 1
KUAN-YU CHEN, 1HAO-WEN LIN
1
Department of Internal Medicine, ANSN Clinic, Hsin-Chu, Taiwan
Background: The prevalence of thyroid nodules is increasing worldwide. Little is known about the prevalence of thyroid nodules in Taiwan, especially in physician clinics. Thyroid fine needle aspiration(TFNA) is a common procedure to evaluate the nature of thyroid nodules, which is mainly performed in regional hospitals or medical centers. The aim of this study was to report the prevalence of thyroid nodules in a health management center and the rate of suspicious malignancy in a primary physician clinic(PPC). Methods: The healthy subjects who received thyroid ultrasonography in the ANSN health management center were extracted to evaluate the prevalence of thyroid nodules. The TFNA was performed in PPC among the subjects who were indicated for further invasive assessment. The study period was January 1, 2019, to November 30, 2021. All thyroid ultrasonography and TFNA were performed by experienced endocrinologists. The result of cytology was reported by The Bethesda System for Reporting Thyroid Cytopathology. Results: There are 2555 healthy subjects who received thyroid ultrasonography in ANSN health management center from December 1, 2020, to November 30, 2021. The prevalence rate of thyroid nodules was 42.5%, and the rate was higher in females rather than male (50.7% versus 37.4%). Among the results of cytology from1988 patients who received TFNA, one-fifth of the results were determined as unsatisfactory/non-diagnostic (US/ND). Two-third of patients were benign. The rate of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and follicular neoplasm/suspicious for a follicular neoplasm (FN/ SFN) were 5.4% and 0.7% respectively. The cytology reported that 2.8% had a diagnosis with suspicious for malignancy (SM) and 3.4% for malignancy. Conclusions: The thyroid nodules were not uncommon in Taiwan. The requirement of
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TFNA was increased along with increasing prevalence of thyroid nodules and thyroid cancer. The rate of suspicious for malignancy (SM) and malignancy via TFNA which was performed in PPC by endocrinologists was higher than national survey in Taiwan.
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Abstract PE-17
A CASE OF SUBACUTE THYROIDITIS AFTER SARS-COV-2 VACCINATION 1
LI-CHUNG HO, 1CHING-HAN LIN, 1HORNG-YIH OU
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Taiwan, R.O.C.
Background SARS-CoV-2 vaccination has been implemented universally in Taiwan due to the COVID-19 pandemic. There were several rare endocrine adverse effects associated with the vaccination. We here described a 52-year-old woman suffered from subacute thyroiditis after SARS-CoV-2 vaccination. Method A 52-year-old woman without any systemic disease received the second dose of ChAdOx1 nCov-19 (Oxford-AstraZeneca). Two days after vaccine injection, she suffered from intermittent fever up to 39 degrees Celsius accompanied with anterior neck pain, swelling, dysphagia, and palpitation. She visited our clinic seven days after vaccine injection. Physical examination showed goiter and diffuse tenderness over thyroid area. Laboratory examination showed thyrotoxicosis (TSH: <0.03 uU/ml, free T4: 4.20 ng/dl) with elevated CRP and ESR level, with negative findings of thyroid antibodies, including anti-TSH receptor Ab, anti-thyroid peroxidase Ab, and anti-thyroglobulin Ab. Thyroid ultrasound revealed diffuse heterogeneously low echogenicity and low vascularity of bilateral thyroid lobes. According to the clinical condition, SARS-CoV-2 vaccine related subacute thyroiditis was impressed. Outcome NSAIDs, steroid, and propranolol were prescribed for symptoms relief of neck pain and palpitation. Two months later, neck pain and symptoms of thyrotoxicosis improved, but general malaise developed. Her thyroid function turned to hypothyroidism (TSH: 46.86 uU/ ml, free T4: 0.64 ng/dl). The clinical course was compatible to the subacute thyroiditis. The patient would undergo radioactive iodine uptake scan in the near future. Conclusion A couple of cases of subacute thyroiditis after SARS-CoV-2 vaccination including 177
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adenovirus vector, m-RNA, and inactivated vaccine has been reported. Although the incidence is low, clinician should be aware of this adverse effect if patients complained about neck pain or swelling after SARS-CoV-2 vaccination.
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Abstract PE-18
GALACTORRHEA AS THE MANIFESTATION OF CRANIOPHARYNGIOMA —A CASE REPORT 1
CHIAO-PI CHENG, 1TZU-YUAN WANG, 1CHING-CHU CHEN, 1CHWEN-TZUEI CHANG, 1 RONG-HSING CHEN, 1WEI-LUN HUANG, 1JUEI-YU TSENG, 1YIN-HUEI CHEN, 1 JIA-YIN GUO, 1YOU-TING LIN 1
Division of Endocrinology and Metabolism, Department of internal medicine, China Medical University Hospital, Taichung, Taiwan
Background: Craniopharyngioma in adult is uncommon. The most common presenting clinical symptoms of adult onset craniopharyngioma (AO-CP) are visual field deficits, headache and signs of hypopituitarism. Hyperprolactinemia with galactorrhea in adult women is usually due to prolactinoma. Galactorrhea as the manifestation of craniopharyngioma in AO-CP is very rare. The etiology of the galactorrhea in patients with craniopharyngiomas is thought to result from tumor mass interference with the secretion of prolactin inhibitory factor either in the hypothalamus or within the hypothalamic-pituitary portal vessels. Methods: Here, we report a case of AO-CP presenting with galactorrhea. Results: A 41-year-old female medical examiner with a history of rhinitis and myoma post operation was admitted via outpatient department because of worsening blurred vision in the recent one month. One year ago, she suffered from blurred vision, but she didn’t pay attention to it. Eight months ago, galactorrhea developed. She visits Obstetrics and Gynecology clinic. The doctor only prescribed cabergoline to control her high prolactin level (47 ng/mL) but ignored the symptom of blurred vision. After taking cabergoline for 2 months, prolactin level reduced to 0.99 ng/mL. Cabergoline was discontinued. However, galactorrhea recurred. She tried to take herb drugs for 6 months, but galactorrhea persisted. One month ago, blurred vision got worse and there was peripheral visual field loss. She called on our neurologic OPD for evaluation. Physical examination revealed a well-developed obese woman weighting 70 kg and measuring 160 cm tall. His heart beat was rapid without murmur and his breath sounds was clear. Visual field test found a bitemporal hemianopia. Pituitary function blood test consisted of the following: ACTH 23 pg/ml, cortisol 20.75μg/dl. TSH 1.07 μIU/mL, free T4 1.2 ng/dl, FSH 6.96 mIU/ml, LH 4.45 mIU/ml, E2 20 pg/ml , prolactin 28.55 ng/mL, growth 179
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hormone 2.0 ng/mL and insulin-like growth factor-1 127 ng/ml. Magnetic resonance imaging (MRI) showed tumor about 3.3 cm in suprasellar region with upward extension, compressing optic chiasm and the 3rd ventricle (figure). Craniopharyngioma was highly suspected and sugary was performed. The pathology of tumor reveals a craniopharyngioma composed of broads strand of a multistrafied squamous epithelium with peripheral palisading od nuclei as well as keratin and dystrophic calcification. Her blurred vision improved after operation, but she developed diabetes insipidus and hypopituitarism which were controlled by medications. Conclusions: Magnetic resonance imaging (MRI) of the sella turcica should be performed in a patient with any degree of hyperprolactinemia with galactorrhea to rule out a mass lesion in the hypothalamic-pituitary region, unless the patient is known to have apparent causes of hyperprolactinemia. AO-CP can present with galactorrhea.
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Abstract PE-19
TC-99M THYROID SCAN PRESENTATION IN A PATIENT WITH SUBACUTE THYROIDITIS AND GRAVES’ DISEASE: A CASE REPORT 1
YI-TING CHIU, 1CHING-CHUNG CHANG, 1CHWEN-TZUEI CHANG, 1 TZU-YUAN WANG, 1JUEI-YU TSENG, 1JIA-YIN GUO, 1CHING-CHU CHEN 1
Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C.
Subacute thyroiditis is an inflammatory disorder of the thyroid, while Graves’ disease is an autoimmune disease that results in the overproduction of thyroid hormones. Simultaneous development of subacute thyroiditis and Graves’ disease is rare and differentiating subacute thyroiditis from Graves’ disease by diagnostic imaging can be useful in clinical practice. Herein, we present a rare case of thyrotoxicosis due to the coexistence of both diseases. Subacute thyroiditis generally displays diffuse homogenous decrease uptake on Tc-99m thyroid scan during the acute stage of subacute thyroiditis. Conversely, it can be readily differentiated from Graves' disease, which shows an enlargement of both thyroid lobes with uniform and increased uptake of radioactive agents. Awareness toward the simultaneous occurrence of subacute thyroiditis and Graves’ disease is important for prompt diagnosis in thyrotoxicosis patients, as interventions can be made and hence conduce to a better outcome.
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PE-20
URINARY IODINE CONCENTRATION OF INDIVIDUALS WITH DIFFERENT HABITUAL IODINE INTAKE 1
SHUN-JIE YANG, 1LIN-HSUAN LEE, 2FAN-FEN WANG, 1CHUN-JUI HUANG
1
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan, R.O.C.
Background: Median urinary iodine concentration (UIC) of spot urine samples has been used to assess iodine nutritional status at the population level. However, one spot urine sample could not reflect the iodine status of an individual due to the large variation in daily iodine intake and thus large variation in UIC. At least ten consecutive spot urine samples of different days are needed to assess an individuals’ iodine status. We report the pattern of consecutive UICs in four subjects with different habitual iodine intake. Methods: Consecutive urine samples for 10-13 days were collected from case 1, 2, and 3 while maintaining their usual dietary habits. To test the effect of ingesting iodine-containing multivitamin on UIC, consecutive urine samples were collected for 9 days initially under daily ingestion of iodine-containing supplement and after two days of wash out period, another round of consecutive urine samples were collected by case 4 while taking iodine-containing supplement every 3 days. A dietary record with photographs of foods eaten were taken by all cases. UIC was measured by a modified microplate method based on the Sandell-Kolthoff reaction. Kruskal–Wallis with Dunn’s post hoc tests and Bonferroni correction was performed to compare the differences in UIC among the cases. Results: Case 1 is a 39-year-old female office worker who cooked every day using iodized salt fortified with potassium iodide 20–33 mg/kg; case 2 is a 23 year-old master student who lived in the university dormitory and ate at bento shops and food stands in the night market nearby the university; case 3 is a 28 year-old male office worker who used noniodized salt at home and ingested kelp on day 4 of urine collection; case 4 is a 37-year old mother of three kids who got the habit of taking multivitamin containing 150 mcg of iodine per tablet since gestation and had the habit of drinking milk at breakfast. The median and mean UIC under five different dietary situations were 159.2 μg/L (IQR: 90.0-225.2) and 156.4 182
Abstract ± 74.8 μg/L for case 1, 91.8 μg/L (IQR: 41.3-118.5) and 88.5 ± 48.0 μg/L for case 2, 80.4μg/ L (42.0-133.6) and 135.3 ± 152.7 μg/L for case 3, 346.6 μg/L (223.0-422.2) and 349.9 ± 152.3 μg/L for case 4 under daily iodine supplement, and 173.1 μg/L (125.1-229.1) and 178.2 ± 67.4 μg/L for case 4 taking one tablet of iodine-containing multivitamin every three days. The daily UIC level was the most stable within the population standard range (100-300 μg/L) in case 1. Eating out (case 2) at bento shops and food stands (which normally uses non-iodized salt) may lower UIC level below the population standard (100 μg/L) as well as household use of non-iodized salt (case 3). The UIC levels appeared to be above the population standard (300 μg/L) in case 4 under daily ingestion of iodine-containing supplement. Statistically significant difference was observed between UICs under five different situations of habitual iodine intake (p<0.001), and the differences were significant between case 2 vs. case 4 (under daily supplement) and case 3 vs. case 4 (under daily supplement) (p<0.001 and p=0.001, respectively). Conclusions: UIC appeared to be the most stable under iodized salt use at home or intermittent and not daily ingestion of iodine containing supplement.
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PE-21
HORNER SYNDROME SUBSEQUENT TO THYROIDECTOMY-TWO CASES REPORT AND LITERATURE REVIEW 1
YU-YEN TSAI, 1SHU-YI WANG
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan
Horner syndrome (HS), which was first described by Horner in 1869, is usually observed in patients with large neck masses or those undergoing head and neck surgery, mainly caused by an interruption in the oculosympathetic pathway. The classic symptoms of HS include partial ptosis (drooping of the upper eyelid), miosis (constricted pupil), and ipsilateral facial anhidrosis (loss of the ability to sweat normally from one side of the face). Kaelin et al. reported the first case of HS subsequent to thyroidectomy in 1915. The incidence of thyroidectomy-related HS is generally low, as it is approximately 0.2%. A previous study reporting the occurrence of HS secondary to thyroidectomy mostly attributed to conventional thyroidectomy. Endoscopic thyroid surgery (ETS) has been widely introduced to clinical practice in recent years due to its property of minimal invasion and postoperative neck cosmetic results. Nevertheless, postoperative complications, such as HS, were also observed with these novel surgical approaches. This report includes 2 female patients, both being diagnosed as papillary thyroid carcinoma with lymph node metastasis and subsequently developed HS after thyroidectomy with lymph node dissection, one of them via ETS and the other via conventional surgical approach. Their symptoms appeared immediately after the operation, and subsided gradually during subsequent follow-up. For most patient of HS, the symptoms are gradually relieved within a few months. Perioperative management plays a crucially important role for reducing the risk of HS. Postoperatively, short-term neurotrophic therapy like vitamin B1 and vitamin B12 (mecobalamin), may help relieve neurologic symptoms of HS. HS is usually transient and insidious without loss of visual function but with cosmetic defects. We present these cases to remind physician paying attention to this rare complication, and also conduct a comprehensive literature review to discuss the possible causes of HS, 184
Abstract its management and the follow-up results, in order to effectively avoid this self-limited but troublesome problem to patient.
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PE-22
SUBACUTE THYROIDITIS AFTER COVID-19 VACCINATION: A CASE REPORT AND LITERATURE REVIEW 1
YUAN-HAO LO, 1CHIA-LUNG HSIEH, 1RUEI-WEN CHEN, 1PI-HSIANG LAI
1
Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan, R.O.C.
Background. Subacute thyroiditis (SAT) has rarely been reported following vaccination such as the influenza vaccine. During the COVID-19 pandemic, emerging cases of SAT after receiving the COVID-19 vaccine were reported in different countries. Methods. We report a patient with SAT after COVID-19 vaccination in Taiwan, who did not have recurrence of SAT following a different type of COVID-19 vaccine. Results. A 46-year-old woman received the first dose of the AstraZeneca vaccine (ChAdOx1) on May 21st, 2021. Fever occurred on the same day. Neck pain, sore throat, palpitation, and dyspnea were found one week later. Four weeks after immunization, she had persistent fever and tenderness of the neck. Laboratory evaluation showed elevated free T4, suppressed thyroid-stimulating hormone (TSH), elevated erythrocyte sedimentation rate, not-high TSH receptor antibody. PCR for COVID-19 was negative. Thyroid ultrasound showed poorly defined patchy hypoechoic areas in bilateral lobes. The patient was prescribed prednisolone, and symptoms subsided. Three months after the first dose of the COVID-19 vaccine, the patient chose to accept a different type of COVID-19 vaccine (Moderna, mRNA-1273). During the follow-up period, there was no recurrence of SAT. Conclusion. We suggest that clinicians should be aware of SAT as the rare but possible adverse effect following COVID-19 vaccination.
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Abstract PE-23
THE POTENTIAL ROLE OF NT-PROBNP (N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE) IN PREDICTING DISEASE ACTIVITY OF GRAVES’ HYPERTHYROIDISM: THE PRELIMINARY REPORT 1
1
WEN-HUI SHIH, 1SHIANG-RONG SHIH, 1CHIH-YUAN WANG
Division of Endocrinology and Metabolism, Department of Internal medicine, National Taiwan University Hospital
Background: Graves’ hyperthyroidism is an autoimmune thyroid disease presenting typical symptoms including tachycardia, hands tremor, body weight reduction with good appetite, and oligomenorrhea in female. The potential catecholamine related response will produce great burden for heart, even high cardiac output failure. Prior studies revealed higher levels of NT-proBNP might be a better and earlier predictor for cardiac failure. Although few reports indicated that NT-proBNP will elevate in certain cases of hyperthyroidism, there was no definite serial designed studies for long term observation. Methods: We retrospectively collected randomized patients with first onset or recurrent hyperthyroidism for observation the probable relationship between NT-proBNP and disease activity of Graves’ hyperthyroidism. We divided such patients into two groups: group A as NT-proBNP less than 125 pg/mL (n=16, average age 37.1±16.9 y/0; 59.3±40.7, SD) and group B as equal/more than 125 pg/mL (n=15, average age 46.7±15.6 y/0; 217.8±107.0, SD), p < 0.05. Results: After preliminary statistical analysis, we cannot find significant correlation between proBNP and other metabolic parameters via linear regression. We also cannot find statistical significance of demographic characters or metabolic parameters (age, BMI, TBII titer, and T3) between two groups. The only interesting finding is the taller of body height revealed the lower levels of proBNP (p = 0.27) in group. Conclusions: It could deserve to design a more delicate survey, include heart sonography, for long term observation of their correlation between proBNP and metabolic parameters, body composition or even predicting Graves’ disease activity and heart outcome.
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PE-24
FIBROBLAST GROWTH FACTOR 23 STIMULATES CARDIAC FIBROBLAST ACTIVITY THROUGH PHOSPHOLIPASE C-MEDIATED CALCIUM SIGNALING 1,2
TING-WEI LEE, 3,4,5CHENG-CHIH CHUNG, 1,2,6TING-I LEE, 3,4,5YUNG-KUO LIN, 7,8 YU-HSUN KAO, 4,5,7,9YI-JEN CHEN 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan, R.O.C.; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan, R.O.C.; 3Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan, R.O.C.; 4Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan, R.O.C.; 5Taipei Heart Institute, Taipei Medical University, Taiwan, R.O.C.; 6 Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan, R.O.C.; 7Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan, R.O.C.; 8 Department of Medical Education and Research, Wan Fang Hospital, Taipei Medical University, Taiwan, R.O.C.; 9 Cardiovascular Research Center, Wan Fang Hospital, Taipei Medical University, Taiwan, R.O.C.
Background: Fibroblast growth factor (FGF)-23 induces hypertrophy and calcium (Ca2+) dysregulation in cardiomyocytes, leading to cardiac arrhythmia and heart failure. However, knowledge regarding the effects of FGF-23 on cardiac fibrogenesis remains limited. This study investigated whether FGF-23 modulates cardiac fibroblast activity and explored its underlying mechanisms. Methods: The migration assay, proliferation analysis, western blot analysis, polymerase chain reaction (PCR), fura-2 ratiometric Ca2+ imaging, and enzyme-linked immunosorbent assay were used to study the fibroblast activity; intracellular Ca2+ content; and expressions of collagen, FGF receptors, and calcium-regulating proteins in control and FGF-23 (25 ng/mL, 48 h)-treated human atrial fibroblasts. Results: We found that FGF-23 increased proliferative and migratory abilities of human atrial fibroblasts. Compared to control cells, FGF-23-treated fibroblasts had a significantly higher Ca2+ entry and intracellular inositol 1,4,5-trisphosphate (IP3) level. FGF-23-treated cardiac fibroblasts had higher expression levels of calcium release-activated calcium channel protein 1 (Orai1) and transient receptor potential canonical (TRPC) 1 channel, but similar expression levels of α-smooth muscle actin, collagen type IA1, collagen type Ⅲ, stromal interaction molecule 1, TRPC 3, TRPC6 and phosphorylated-calcium/calmodulin-dependent 188
Abstract protein kinase II when compared with control fibroblasts. In the presence of ethylene glycol tetra-acetic acid (a free Ca2+ chelator, 1 mM) or U73122 (an inhibitor of phospholipase C, 1 μM), control and FGF-23-treated fibroblasts exhibited similar proliferative and migratory abilities. Moreover, PCR analysis revealed that atrial fibroblasts abundantly expressed FGF receptor 1 but lacked expressions of FGF receptors 2–4. FGF-23 significantly increased the phosphorylation of FGF receptor 1. Treatment with PD166866 (an antagonist of FGF receptor 1, 1 μM) attenuated the effects of FGF-23 on cardiac fibroblast activity. Conclusions: FGF-23 may activate FGF receptor 1 and subsequently phospholipase C/ IP3 signaling pathway, leading to an upregulation of Orai1 and/or TRPC1-mediated Ca2+ entry and thus enhancing human atrial fibroblast activity.
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PE-25
METHIMAZOLE INDUCED INSULIN AUTOIMMUNE HYPOGLYCEMIA IN GRAVES DISEASE YOUNG FEMALE PATIENT 1
I-HUA CHEN, 2HSUAN- YU WU, 1,3SHANG-JYH HWANG, 1,2MEI-YUEH LEE
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan; 2School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
Hypoglycemia is an emergent condition with multifactorial causes, including underlying diabetes mellitus either using insulin or taking oral anti-diabetic medication for glucose control, and organ (heart, hepatic or renal) failure. However, insulin autoimmune syndrome (IAS) is relatively difficult for us to take into account, as it is rare clinically. Though uncommon, IAS can be possibly life threatening if persistent hypoglycemia exists. Herein, we present a case of 27-year-old female with underlying Graves’ disease. The patient was treated with methimazole (MTZ), but hypoglycemia symptoms accompanied by dizziness and cold sweating occurred after six weeks treatment. We excluded the causes of underlying diabetes mellitus using insulin nor taking oral anti-diabetic medication. Laboratory data shown elevated insulin and C-peptide levels. Therefore, insulinoma and IAS were taken into consideration. Eventually, abdominal computed tomography(CT) and magnetic resonance imaging(MRI) rule out insulinoma, and medication MTZ induced IAS was finally considered. Hypoglycemia symptoms resolved after MTZ switched to propylthiuracil (PTU) confirmed the diagnosis of IAS.
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Abstract PE-26
LITHIUM-INDUCED NEPHROGENIC DIABETES INSIPIDUS: A CASE REPORT 1
LI-HSIN PAN, 1XIN-NING NG, 1GUAN-YU SU, 1HSIN-YEN CHEN, 1CHI-MIN HWU
1
Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
Background: Diabetes insipidus(DI) is characterized by polyuria and polydipsia. Central DI results from vasopressin deficiency, while nephrogenic DI is attributed to poor renal response to vasopressin. Differential diagnosis between central DI and nephrogenic DI relies on water deprivation test or measurement of ADH level. Lithium use is the most common cause of nephrogenic DI. Methods: We report a case of a patient with lithium-induced nephrogenic diabetes insipidus. Results: A 49-year-old man had schizoaffective disorder and took lithium regularly for many years. He was admitted because of hyperosmolar hyperglycemic state(HHS). Severe polyuria, polydipsia with hypernatremia were noticed after complete treatment of HHS. The urine osmolality was 102 mOsm/kgH2O. Water deprivation test revealed less than 50% increase in urine osmolality which was still below 300 mOsm/kgH2O after desmopressin acetate injection. Lithium-induced nephrogenic DI was highly suspected. Lithium was shifted to valproic acid and trihexyphenidol. Low-sodium diet and hydrochlorothiazide 25 mg/day were administered. The urine output decreased significantly. Hypernatremia and low urine osmolality also resolved. Conclusions: Lithium therapy reduces aquaporin-2 expression, impairs concentrating ability of kidneys and decreases renal response to aldosterone. Early cessation of lithium may induce complete resolution of nephrogenic DI. Frequent monitoring of lithium level may help prevent lithium-induced DI.
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PE-27
ASYMPTOMATIC HYPERCALCEMIA DUE TO PARATHYROID ADENOMA WITH INCIDENTAL PAPILLARY CARCINOMA OF THYROID: A CASE REPORT AND REVIEW OF THE LITERATURE 1
CHIA-CHUAN CHANG, 4SHENG-CHUN WANG, 1,2WEN-YA MA, 1,2,3MYO MYO AYE
1
Department of Internal Medicine, Cardinal Tien Hospital , New Taipei City, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardinal Tien Hospital , New Taipei City, Taiwan; 3Division of Geriatrics and Gerontology, Department of Internal Medicine, Cardinal Tien Hospital , New Taipei City, Taiwan ; 4Department of General Surgery, Cardinal Tien Hospital , New Taipei City, Taiwan
Background: 70years old woman with asymptomatic hypercalcemia - routine laboratory examination show serum calcium 18.5mg/dL but her consciousness was clear.Poor intake and general malaise was due to compression of huge goiter .So we survey for differential diagnosis of hypercalcemia accodring to flow chat. Analysis of calcium clearance to creatinine clearance ratio which was <0.01. Therefore, her serum parathyroid level was checked which was markedly elevated 1364.4 pg/mL due to Parathyroid Adenoma, reference range18.5-88.0, our impression was hypercalcemia due to primary hyperparathyroidism. We arrange parathyroid scan for localized parathyroid tumor. Parathyroid scan show hyperfunctioning of superior aspect of right parathyroid gland. So general surgeon decided for her parathyroidectomy. During operation, bilateral thyroid nodules were dissected and send for frozen section which show papillary thyroid carcinoma. Conclusions: Un-diagnosed concomitant thyroid nodules represent the main hazard to minimally invasive procedures for parathyroid adenomas. Associated thyroid nodular pathology in patients with PHPT should therefore not be neglected and FNAB of larger thyroid nodules should be routinely performed in these cases.
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Abstract PE-28
POSTPARTUM THYROIDITIS: A CASE REPORT 1
CHING YUN HU, 2,3KAI LUN CHENG
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Lin Shin Medical Corporation Wuri Lin Shin Hospital, Taichung, Taiwan; 2Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan; 3School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
Background: Postpartum thyroiditis (PPT), an autoimmune-mediated destructive thyroid pathology, affects 5-10% of postnatal women worldwide. The presence of antibodies against thyroid peroxidase (TPO) plays an important role. PPT occurs to women without a pre-existing thyroid disease within the first year postpartum (1,2). Patients may present with transient hyperthyroidism, transient hypothyroidism, or typical progress from hyperthyroidism to hypothyroidism with spontaneous recovery. Although for most patients the disease does not require treatment, a small proportion of them develops long-term hypothyroidism (3,4). Here we share our experience on an accidental detection of PPT. Case Presentation: A 35-year-old woman has left thyroid goiter (size: 16.9*24.8*37.6mm) diagnosed at age of 32. She gave birth to her second child in March 2021. Her two pregnancies and childbirths were uneventful. In May 2021, she had a routine goiter evaluation. Her thyroid lobes appeared homogeneous isoechoic on ultrasound images. Serum exams showed: TSH 2.43 uIU/ml, Free T4 1.272 ng/dl, anti-TPO antibody 75 IU/mL, TSH receptor antibody 1.91 %. Radiofrequency ablation (RFA) to her goiter was arranged due to obvious cosmetic problem. When she visited the hospital for RFA management in August 2021, 5 months postpartum, the thyroid ultrasound showed heterogeneous content, mainly hypoechoic change of thyroid parenchyma. Thus, thyroid function test was arranged again. Serum exams revealed: TSH <0.03 uIU/ml, Free T4 2.622 ng/dl, anti-TPO antibody 751.60 IU/mL, TSH receptor antibody < 0.1%. The patient felt fatigue and neck swelling for two months, but reported no palpitation, tremor, or body weight loss. Postpartum thyroiditis was impressed. The RFA was cancelled. Due to no obvious hyperthyroidism symptoms, the patient did not receive any medications. Four months later, her TSH became 4.0 uIU/ml, Free T4: 0.91 ng/dL, and Anti TPO antibody 799 IU/mL. The patient kept regular follow-ups in our outpatient department. Discussion: The case we shared had one risk factor of PPT and presented with 193
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
inconspicuous symptoms. Established risk factors of PPT include positive anti-TPO antibodies detected during pregnancy, type 1 diabetes mellitus, systemic lupus erythematous, and history of PPT following previous pregnancies (1). As women with PPT have different levels of thyroid function abnormalities, the clinical symptoms also vary between each individual. Some symptoms, like fatigue, anxiety, changes in body weight, or deteriorations in concentration and memory, are not uncommon in normal postpartum women. As a result, the detection of PPT relies heavily on clinicians’ awareness of this disease. Currently, screening of PPT in high-risk populations in the 3rd and 6th postpartum months is recommended (1). Conclusion: We report a typical case of postpartum thyroiditis with serial change of thyroid function and ultrasound image. We hope that this case sharing help raise medical care providers’ awareness of PPT, since the symptoms of PPT may not be easily distinguished from normal puerperium complaints.
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Abstract PE-29
THYROID ABSCESS WITH ASPERGILLOSIS INFECTION: A CASE REPORT 1
HAN-SHENG LU, 2TZU-JU CHEN, 1PO-TSANG CHENG
1
Division of Endocrinology and metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Clinical Pathology Department, Chi Mei Medical Center, Tainan, Taiwan
Background: Thyroid abscesses are rare case in neck infection and often delay diagnosed when patient under fever condition without finding obvious infection source. Neck mass with further fine-needle aspiration is the key point to confirm the diagnosis. Methods: We reported a case of thyroid abscess with aspergillosis infection in whom the diagnosis was confirmed by fine-needle aspiration. Results: A 67-year-old female with underlying primary Sjogren’s syndrome and autoimmune hepatitis presented with fever, chills, neck mass and neck stiffness. Laboratory data revealed C- reactive protein and normal thyroid function. Thyroid ultrasonography revealed multiple hypo-echoic nodules. Thus, fine-needle aspiration was performed and thyroid abscess with aspergillosis infection was diagnosed under cell block and fungus culture. Her symptom improved after abscess drainage and anti-fungal medication. Conclusions: Thyroid abscess should be considered in immunocompromise patient suffered from fever with neck mass. Thyroid ultrasonography, fine-needle aspiration and culture are important for diagnosis.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PE-30
TAKOTSUBO CARDIOMYOPATHY ASSOCIATED WITH HYPERTHYROIDISM: A CASE REPORT 1
SHANG-HSIEN WU, 1PO-TSANG CHEN, 1CHWEN-YI YANG, 2SHENG-CHUNG HUANG
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Taiwan, R.O.C; 2Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Taiwan, R.O.C.
Background: Takotsubo cardiomyopathy, also called stress myocardiopathy, is a syndrome characterized by acute left ventricular dysfunction with regional wall motion abnormalities, mimicking myocardial infarction, but without angiographic evidence of occlusive coronary artery disease. Hyperthyroidism may affect the heart and cause diseases like atrial fibrillation or heart failure. There were some reports of Takotsubo cardiomyopathy associated with hyperthyroidism. Methods: Here we report a 46-year-old woman with takotsubo cardiomyopathy associated with hyperthyroidism caused by Graves' disease. Results: The 46-year-old woman without history of hypertension, diabetes or tobacco use presented to our hospital with anterior chest pain. Laboratory tests showed dynamic elevation of high sensitive troponin-I level (initial 264.9 pg/mL, peak 12412 pg/L; normal range 0-26.2 pg/mL). Coronary angiography showed no evidence of occlusive coronary artery disease. The ventriculography showed regional wall abnormalities and takotsubo cardiomyopathy was suspected. Tracing back her history, signs of hyperthyroidism like palpitation, heat intolerance and body weight were noted in recent months and hyperthyroidism was confirmed by a low thyroid stimulating hormone and high free thyroxine levels. Standard treatment of hyperthyroidism was given. The clinical condition improved in 3 days. Echocardiography 3 days after admission showed recovery of regional wall abnormality. Conclusions: Hyperthyroidism can present as takotsubo cardiomyopathy with chest pain and elevated cardiac enzyme, mimicking myocardial infarction. In patients presenting with chest pain, 196
Abstract thyroid disorders should be taken into consideration, especially in patients with low risk for atherosclerosis cardiovascular disease.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PE-31
CASE REPORT: GENETIC MARKERS GUIDING MANAGEMENT IN A PATIENT WITH ATYPIA CYTOLOGY OF THYROID NODULES 1
YI-CHING TSAI, 1CHING-CHUNG CHANG, 1CHING-CHU CHEN, 1CHWEN-TZUEI CHANG, 1 RONG-HSHING CHEN, 1TZU-YUAN WANG, 1WEI-LUN HUANG, 1JUEI-YU TSENG, 1 YIN-HUEI CHEN, 1JIA-YIN GUO, 1YOU-TING LIN
1
Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
Background: Atypia cytology of thyroid nodules usually make the physician and the patient facing a dilemma of treatment plan. It may indicating 20-25% of malignancy. However, diagnostic thyroidectomy may expose the patient to risk of complication of surgery. Many genetic markers were found to be related with thyroid cancer. They are promising to provide more information to the management of thyroid nodules. Case report: A 30 years old female patient presented to our hospital due to right lower neck mass noted for 3 months. Thyroid echo showed 3 nodules around 1.5cm in each dimension over right lobe, one nodule over left lobe, and one nodule over isthmus. Fine needle aspiration to nodules was done. The cytology showed atypia. The thyroid genetic mutation test showed positive for BRAF V600E and PIK3CA. Due to high risk of cancer, the patient received total thyroidectomy. The final pathology staging showed pT1bNXcM0, age under 55 years old, stage I. (AJCC, 8th edition). Discussion: The most common mutation in 40–80% of papillary thyroid cancer is BRAFV600E. In our case, the thyroid nodule showed high risk for malignancy under sonography but the cytology revealed atypia which makes hard decision whether to manage the nodule conservatively with observation or aggressively with surgery. The genetic markers showed high relationship with malignancy thus surgery was suggested and revealed thyroid papillary carcinoma. Conclusion: 198
Abstract In this case, gene mutation marker testing provides a potentially additional reference for the physician and the patient to discuss about a more aggressive managment of thyroid nodules.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PE-32
CATECHOLAMINE-MEDIATED MYOCARDITIS WITH CARDIOGENIC SHOCK IN PHEOCHROMOCYTOMA AND NEUROFIBROMATOSIS TYPE 1 PATIENT 1
LI-CHING LI, 1EDY KORNELIUS, 1SHIH-CHANG LO, 1CHIEN-NING HUANG, 1 YI-SUN YANG 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taiwan, R.O.C.
Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant condition that has a variety of clinical manifestations. The course of pheochromocytoma in NF1 is associated with an unpredictable presentation and adverse outcomes. We present a rare case of catecholaminemediated myocarditis and complicated with acute heart failure due to pheochromocytoma crisis in patient with NF1. Case Report: A 29-year-old female who has no relevant past medical or surgical history, admitted to our unit for myocarditis with pulmonary edema, requiring extracorporeal membrane oxygenation and inotropes infusion. Despite such treatment, the patient developed multiorgan failure and need continuous arteriovenous hemodialysis for acute kidney injury. Abdominal sonogram and CT were arranged for elevated liver enzymes, incidentally found a complex cystic lesion measuring 7.2 x 5 cm at right adrenal gland which was suspected to be a pheochromocytoma. Urinary catecholamines and vanillylmandelic acid were markedly elevated. After stable condition, patient was treated for two weeks with alpha and beta blockers preoperatively followed by right adrenalectomy. On physical examination, characteristic skin lesions such as multiple small cafè-au-lait spots on the chest and back, freckles on both axillae and neurofibromas contributed to diagnosis of NF1. Furthermore, iris hamartomas and bilateral choroidal nodules, plexiform neurofibroma over right posterior parietal scalp were also noted. Similar skin lesions were seen in her mother, brother and sister. Genetic testing can be performed to confirm the diagnosis and to assist the direct screening of family members. Conclusions: 200
Abstract Pheochromocytoma, although a rare condition in patients with neurofibromatosis, may cause uncontrolled hypertension, as well as other life threatening cardiovascular complications. Screening of NF1 patients for hypertension and/or elevated circulating catecholamines could play an important role in preventing pheochromocytoma crisis.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PE-33
ENDOCRINOPATHIES IN BETA-THALASSEMIA MAJOR: A CASE REPORT 1
CHING-MEI HSU, 1EDY KORNELIUS, 1SHIH-CHANG LO, 1CHIEN-NING HUANG, 1 YI-SUN YANG 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, R.O.C.
Background: Intensive blood transfusion therapy in thalassemia major patients can lead to iron overload (hemochromatosis) and iron tissue toxicity causing structural, metabolic and endocrine abnormalities. The presence of concomitant anemia, chronic liver disease, nutrition deficiency and cardiomyopathy affect the development and treatment of endocrine disorders. We hereby report a case of thalassemia major with multiple endocrine disorders associated with transfusional hemochromatosis. Case report: We present a case of 29-year-old unmarried man with thalassemia major developed endocrinopathies included short stature in childhood and adolescence, diabetes mellitus and hypogonadism. He was given a diagnosis of thalassemia major at age of eight. He had a height of 110 centimeter in the third year of junior high school and received growth hormone therapy until he was eighteen. In the past three years, he received regular blood transfusion (4 units of blood monthly) and intravenous chelation therapy. On physical examination, he had bronze skin color, sparse face hair and axillary hair, no pubic hair growth in inner thigh (Tanner stage of 4). Laboratory data showed HbAlc 7.3%, glucose AC 170mg/dl, serum testosterone 0.47ng/ml, AST 66 IU/l, ALT 88 IU/L, total bilirubin 2.1mg/dl, ferritin 4068 ng/ml, FSH 1.43 mIU/ml and LH 1.67 mIU/ml. His thyroid, parathyroid and adrenal function were normal. After stimulation with LHRH, peak levels of FSH and LH were 1.87 mIU/ml and 4.33 mIU/ ml, respectively. Pituitary response was subnormal, consistent with hypogonadotropic hypogonadism. Magnetic resonance imaging (MRI) brain study revealed a small Rathke’s cleft cyst in posterior aspect of the pituitary gland. With these findings, the patient was accepted as hypogonadotropic hypogonadism resulting from iron deposition in the pituitary 202
Abstract gland. Testosterone therapy and oral hypoglycemic medicine (Glucomine 500mg bid) were then prescribed for hypogonadism and diabetes mellitus. Conclusion: With this case, we aim to raise awareness of endocrinopathies in patients with intensive transfused thalassemia major. Appropriate prevention by adequate chelation therapy and periodic monitoring of endocrine function are essential to achieve a good quality of life in thalassemia major.
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PD-1
DECREASED RISK OF ANXIETY IN DIABETIC PATIENTS RECEIVING GLP-1 RECEPTOR AGONIST: A NATIONWIDE, POPULATION-BASED COHORT STUDY 1
WEN-HSUAN TSAI, 2FUNG-CHANG SUNG, 2LU-TING CHIU, 1MING-CHIEH TSAI, 3 SHU-I WU 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; 2Management Office for Health Data (DryLab), Clinical Trial Research Center (CTC), China Medical University Hospital, Taiwan; 3Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
Background: Previous findings on using Glucagon-like peptide-1 receptor agonist (GLP1-RA) as an antidepressant were conflicting, lacking large-scale studies. We used population-based data to investigate depression and anxiety risk in diabetic patients receiving the medication. Methods: From claims records of the National Health Insurance Research Database (NHIRD) of Taiwan, we identified cohorts of 16,149 GLP1-RA users and 64,596 non-users from diabetes mellitus (DM) patients diagnosed in 2011-2017, matched by age, gender, and diagnosis year. Incidence, and hazard ratios (HR) and 95% confidence interval (CI) of depression and/or anxiety were estimated by the end of 2017. Results: The overall combined incidence of anxiety and/or depression was lower in GLP1-RA users than in non-users (6.20 versus 7.72 per 1000 person-years), with an adjusted HR (aHR) of 0.76 (95% CI: 0.63-0.90) after controlling for covariates. The absolute incidence reduction was greater in anxiety (1.42 per 1000 person-years) than in depression (0.23 per 1000 personyears). The treatment effectiveness decreased with increasing age, which was significant for women. Patients taking GLP1-RA for longer than 180 days had the incidence of depression reduced to 2.59 per 1000 person-years, with an aHR of 0.57 (95%CI: 0.38~0.85), compared to non-users. The corresponding incidence of anxiety was 3.39 per 1000 person-years, with an aHR of 0.57 (95%CI: 0.40~0.82). Conclusions: 204
Abstract Patients with DM receiving GLP1-RA therapy have a greater reduction of the risk of anxiety than that of depression. Our findings strengthen previous research that advocated possible anti-depressant or anxiolytic effects of GLP1-RA and may lead to improved treatment adherence among DM patients.
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PD-2
MULTICENTRIC INSULINOMA: A CASE REPORT 1
XIN NING NG, 2CHUN-FENG WU, 1CHII-MIN HWU
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
Background: Insulinomas are the most common functional pancreatic neuroendocrine tumor that results in endogenous hyperinsulinism. They are typically solitary benign neoplasms, which occur sporadically and can be cured with surgical resection. Multicentric insulinoma is rare and tend to be associated with multiple endocrine neoplasia (MEN1) syndrome or insulinomatosis. Methods: We present a case of multicentric insulinoma, manifesting as hyperinsulinemic hypoglycemia. Results: We present the case of a 60-year-old woman with presentation of fatigue, lightheadedness, diaphoresis, and near fainting. Hypoglycemia along with elevated insulin and C-peptide level were demonstrated. Her symptoms resolved promptly after glucose administration. Computed tomography scan and endoscopic ultrasound both confirmed the presence of two pancreatic insulinomas. The patient underwent successful surgical resection with complete resolution of symptoms thereafter. Conclusion: Multicentric insulinomas should raise suspicion for MEN1 or insulinomatosis, which required lifelong active surveillance to evaluate subsequent development of disease recurrence.
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Abstract PD-3
EFFICACY AND ACCEPTABILITY OF NONINVASIVE BRAIN STIMULATION INTERVENTIONS FOR WEIGHT REDUCTION IN OBESITY: A PILOT NETWORK META-ANALYSIS 1
BING-YAN ZENG, 2CHENG-TA LI
1
Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan; 2Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
Background/objectives: Obesity has recently been recognized as a neurocognitive disorder involving circuits associated with the reward system and the dorsolateral prefrontal cortex (DLPFC). Noninvasive brain stimulation (NIBS) has been proposed as a strategy for the management of obesity. However, the results have been inconclusive. The aim of the current network meta-analysis (NMA) was to evaluate the efficacy and acceptability of different NIBS modalities for weight reduction in participants with obesity. Methods: Randomized controlled trials (RCTs) examining NIBS interventions in patients with obesity were analyzed using the frequentist model of NMA. The coprimary outcome was change in body mass index (BMI) and acceptability, which was calculated using the dropout rate. Results: Overall, the current NMA, consisting of eight RCTs, revealed that the highfrequency repetitive transcranial magnetic stimulation (TMS) over the left DLPFC was ranked to be associated with the second-largest decrease in BMI and the largest decrease in total energy intake and craving severity, whereas the high-frequency deep TMS over bilateral DLPFC and the insula was ranked to be associated with the largest decrease in BMI. Conclusion: This pilot study provided a "signal" for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on weight reduction in participants with obesity by different NIBS interventions.
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PD-4
ASSOCIATION BETWEEN THE USE OF DIPEPTIDYL PEPTIDASE 4 INHIBITORS AND THE RISK OF OSTEOPOROSIS AMONG PATIENTS WITH TYPE 2 DIABETES IN TAIWAN 1
CHIA-HAO CHANG, 2CHIEH-HUA LU, 3CHI-HSIANG CHUNG, 2SHENG-CHIANG SU, 2 FENG-CHIH KUO, 2JHIH-SYUAN LIU, 2PENG-FEI LI, 2CHIA-LUEN HUANG, 2 LI-JU HO, 2KUAN-CHAN CHEN, 2NAIN-FENG CHU, 2CHIEN-HSING LEE, 4 YI-JEN HUNG, 2CHANG-HSUN HSIEH, 3WU-CHIEN CHIEN 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taiwan, R.O.C.; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, TriService General Hospital, Taiwan, R.O.C.; 3School of Public Health, National Defense Medical Center, Taiwan, R.O.C.; 4Institute of Preventive Medicine, National Defense Medical Center, Taiwan, R.O.C.
Background: Diabetic patients have a relatively high risk of fracture due to osteoporosis. However, the risk of an association between oral hypoglycemic drugs dipeptidyl peptidase 4 inhibitor (DPP-4i) and osteoporosis is unclear. This study aimed to explore the impact of DPP4i on the risk of osteoporosis in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods: This study enrolled 6,339 patients on DPP-4i use (DPP-4i group), and 25,356 patients without DPP-4i use (non-DPP-4i group) were matched by 1:4 propensity score matching using confounding variables including sex, age, comorbidities, medication, and index year. Cox proportional hazards analysis was used to compare hospitalization and mortality during an average 7-year follow-up period. Results: The average age of the two groups was 66 years old. Males were slightly dominant (51.79%). At the end of the follow-up, 113 (0.36%) of all enrolled subjects had osteoporosis, of which 15 cases (0.24%) were in the case group and the control group 98 (0.39%). The risk of all-cause osteoporosis was significantly lower in the DPP-4i group than in the non-DPP-4i group (adjusted hazard ratio (HR) 0.616; 95% confidence interval (CI) 0.358-0.961; p=0.011). The Kaplan-Meier analysis showed that the preventive effect on osteoporosis was positively correlated with the cumulative dose of DPP-4i (log-rank, p=0.039) with class effect. Conclusions: Compared with non-DPP-4i use, the use of DPP-4i in Taiwanese T2DM patients is associated with a lower risk of osteoporosis of class effect and preventive effect was dose-dependent. It may need larger, prospective study to validate this finding and explore the possible mechanism of preventive effect of DPP-4i. 208
Abstract PD-5
A TYPE 1 DIABETES MELLITUS PATIENT WITH REFRACTORY DIABETIC GASTROPARESIS WHO IMPROVED AFTER SURGICAL TREATMENT - A CASE REPORT 1
YUN-CHI LEE, 1RONG-HSHING CHEN, 1CHING-CHU CHEN, 2CHIH-KUN HUANG
1
Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; 2Superintendent, Body science & Metabolic disorders International (B.M.I) Medical Center, China Medical University Hospital,Taichung city, Taiwan
Diabetic gastroparesis is a serious diabetes complication marked by delayed gastric emptying and associated upper gastrointestinal symptoms in the absence of any mechanical obstruction. The presence of gastroparesis symptoms, the absence of gastric outlet obstruction, and a delay in gastric emptying are used to make the diagnosis of gastroparesis. Gastric emptying scintigraphy of a radiolabeled solid meal is the gold standard for the diagnosis of gastroparesis. Gastric emptying considered delayed if there is greater than 60% retention at 2 hour or 10% retention at 4 hour. Management of diabetic gastroparesis includes nutrition support, intensive glycemic control and pharmacologic treatment. However, a significant number of patients suffer from gastroparesis that is resistant to medical treatment. If medical treatment results in only minor improvement, we will consider surgical intervention. In Taiwan, surgical intervention was rarely reported. We present a case of a type 1 diabetes mellitus patient with severe diabetic gastroparesis who improved following laparoscopic pyloroplasty and Roux-en-Y gastrojejunostomy surgery.
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PD-6
ALPELISIB INDUCED DIABETIC KETOACIDOSIS: A CASE REPORT 1
YI-HONG LEE, 1YING-CHUN LAI, 2YEN-SHEN LU
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
Background Alpelisib is an α-selective phosphatidylinositol 3-kinase (PI3K) inhibitor and is effective in some breast cancer. However, the medication can block intracellular action of insulin, and in turn cause hyperglycemia, or even diabetic ketoacidosis. Under the condition, it is important to closely monitor the serum glucose in patients receiving alpelisib treatment. Case report A 78-year-old female presented to our oncology clinic with general weakness, malaise, dizziness, nausea, thirst, and poor appetite. Her past medical history is significant for metastatic breast cancer, with known PIK3CA mutation, started on alpelisib 1 week prior. She had no history of diabetes mellitus. However, the serum glucose test at the clinic was 400~500mg/dL. Laboratory data showed evident leukocytosis (90k/mcL), metabolic acidosis with respiratory compensation, and elevated ketone of 5.5mmol/L. After admission to the medical ICU, insulin infusion, fluid and electrolyte supplement were administered. The ketonemia resolved and the patient was switched ward after 1 day. The patient was in euglycemia condition under the basal insulin and several oral hypoglycemia agents (Metformin, Pioglitazone and Dapagliflozin). Under the concern of insulin may hamper the efficacy of alpelisib, insulin was discontinued later and then the serum glucose was around 200~300 mg/dL. During the process, the anti-cancer therapy was still administered. However, the patient was found having progressive pneumonia after chemotherapy and subsequently evolved to acute respiratory distress syndrome on 2 weeks later, and subsequently died of septic shock 6 weeks later. Conclusion Diabetic ketoacidosis is a rare but life-threatening side effect of Alpelisib, even in patients without an underlying diagnosis of diabetes mellitus. To offer an appropriate treatment, oncologists and endocrinologists should co-operate in this condition and closely monitor the clinical responses. 210
Abstract PD-7
ASSOCIATION BETWEEN DAILY MILK INTAKE AND COGNITIVE IMPAIRMENT IN OLDER PEOPLE 1,2
YUN-JU LAI, 2,3YUNG-FENG YEN, 4LI-JUNG CHEN, 5PO-WEN KU, 6YU-KAI LIN
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; 2School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3 Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan; 4Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan; 5Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan; 6Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
Background: With the rapid aging of the population, the prevalence of cognitive impairment in the older population has continued to increase. Previous studies have demonstrated that lifestyle factors are associated with cognitive impairment in older populations. However, the association between daily milk intake and cognitive impairment remains unclear. Methods: The annual health examination data of older adults aged 65 years and above from 2006 to 2010 in Taipei were analyzed in this study. Those who had participated in the health examination more than twice were enrolled. Information on the baseline characteristics and health habits, including daily milk intake, was collected through face-to-face interviews. Laboratory data, including blood glucose, lipid profiles, and thyroid function tests, were examined after 8 h of fasting. The Short Portable Mental State Questionnaire was used to evaluate the cognitive state. A logistic regression model with a generalized estimation equation was adopted for repeated measurement analysis to evaluate the association between daily milk intake and cognitive impairment. Results: A total of 91,353 participants were enrolled in the analysis. Among them, 46,369 (50.76%) were men, and the mean age was 73.44 ± 6.69 years. A total of 3,932 (4.3%) older adults had impaired cognitive function. The univariable logistic regression analysis showed that older people with daily milk intake had a higher risk of cognitive impairment than those without daily milk intake (odds ratio (OR)=1.21, 95% confidence interval (CI)=1.14–1.27). 211
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After adjusting for potential confounders, older people with daily milk intake were associated with a higher risk of cognitive impairment than those without daily milk intake (adjusted OR=1.24, 95% CI=1.15–1.33). Conclusions: Older people with daily milk intake had a significantly higher risk of cognitive impairment than those without daily milk intake.
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Abstract PD-8
THE PREVALENCE OF HEPATITIS C VIRUS SEROPOSITIVE IN DIABETES POPULATION: A SOUTH TAIWAN SINGLE CENTER STUDY 1
LAY SAN LIM, 1PEI-WEN WANG, 1JUNG-FU CHEN, 1MING-CHUN KUO, 1 SHAO-WEN WENG, 1FENG-CHIH SHEN, 1CHIA-JEN TSAI, 1CHIH-MIN CHANG, 1 CHENG-FENG TSAO, 1YUNG-NIEN CHEN, 1YI-TING YANG, 2TSUNG-HUI HU, 1 CHEN-KAI CHOU 1
Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Background: Previous studies reported that the higher prevalence of type 2 diabetes mellitus in hepatitis C virus (HCV) seropositive and/or infected population, especially those with cirrhotic changes. Several mechanisms had been proposed about the association of HCV and diabetes, mainly through development of insulin resistance due to inflammation and oxidative stress. However, no valid data about the prevalence of HCV in diabetes population. This study was aimed to investigate the prevalence of hepatitis C virus seropositive in diabetes population. Methods: We conducted a retrospective study at Kaohsiung Chang Gung Memorial Hospital. There were 13238 diabetic patients in our hospital enrolled in Taiwan’s diabetes shared care program between June 2019 to May 2020. Data about anti-HCV Ab, HCV RNA and treatment of HCV were retrieved retrospectively from these patients’ electronic medical records till December 2021. Patients with serum anti-HCV antibody data were enrolled in this study. Results: 7179 patients had been screened for anti-HCV antibody and 727 turned out HCV seropositive. Among 727 HCV seropositive patients, 410 patients were further investigated with HCV RNA, which revealed 50% were viremic by detectable HCV RNA. 158 had completed HCV treatment with either interferon-based therapy or direct-acting antivirals (DAAs). Conclusions: The prevalence of hepatitis C virus seropositive in diabetes population is 10.13%, which was higher compared to general population. For those HCV seropositive 213
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
patients who further investigated with HCV RNA, half of them were viremia and need further HCV treatment. Our study has shown that HCV is an important issue in diabetes population and recommended that diabetic patients to receive HCV screening due to the high prevalence and viremic status.
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Abstract PD-9
ENDOGENOUS NON-STRUCTURAL PROTEIN 4 OF HEPATITIS C VIRUS INDUCED INSULIN RESISTANCE THROUGH INTERFERING VITAMIN A SIGNALING OF LIVER 1
PI-CHEN LIN, 2HUEI-MING SHIH, 2RONG-TING TSAI, 3KUAN-HSUAN CHEN, 1 HSING-YI HUANG, 2,4CHAO-HUNG CHEN 1
Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan; 3Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 4General Research Service Center, National Pingtung University of Science and Technology, Pingtung, Taiwan
Background: Vitamin A deficiency (VAD) are commonly encountered in patients with liver cirrhosis including hepatitis C. In addition, clinic study also indicates VAD is maybe occurrence in patients with metabolic syndrome (MS). Clinic studies indicates VAD is associated with nonresponse to antiviral therapy for hepatitis C. Nonstructural protein 4 (NS4) of hepatitis C virus (HCV) has been considered association with fibrosis and carcinogenesis under chronic HCV infection. However, the pathological roles and mechanisms of NS4 remain to be elucidated in VAD of MS patients with hepatitis C . Methods: In present study, experimental mice was transduced with adeno-associated virus (AAV)carried plasmid of NS4 cDNA through vein injection for 4 weeks. At end point, mice were been sacrificed, and then liver were collected for analyzing vitamin A and insulin signaling. In vitro, human hepatocyte, HepG2 were transfected with NS4 vector, and then stimulated with additional insulin for investigating responses of vitamin A metabolism and insulin signaling. Results: After 4 week experiment, blood glucose and retinol binding protein 4 (RBP4) significantly elevated in AAV-NS4 transduced mice. Immunohistochemistry demonstrated that insulin signaling (p-IRS, p-PIP3, and p-Akt) and vitamin A signaling (RBPR2, CRBP1, RARα) were both reduced by AAV-NS4 transduction in vivo. Similarly. Vitamin A and insulin signaling also repressed in NS4-transfected HepG2 cells under insulin stimulation. 215
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Conclusions: This study confirm NS4 could interfere vitamin A and insulin signaling. This results implies that chronic HCV infection causes vitamin A deficiency-related insulin resistance.
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Abstract PD-10
ENDOGENOUS HEPATITIS B CORE PROTEIN (HBC) IMPAIRED INSULIN SECRETION AND PROMOTED FIBROSIS IN ISLETS 1
PI-CHEN LIN, 2RONG-TING TSAI, 2HUEI-MING SHIH, 1,3KUAN-HSUAN CHEN, 1 HSING-YI HUANG, 2,4CHAO-HUNG CHEN 1
Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan; 3Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 4General Research Service Center, National Pingtung University of Science and Technology, Pingtung, Taiwan
Background: Hepatitis B core protein (HBc) has been considered as specific and immunologic bio-functional characters. Clinic studies confirm correlation between chronic hepatitis B and diabetes, and possibility of HBV-infected pancreas, suggesting Hepatitis B has been considered as risk of pancreatogenic (Type 3c) diabetes. However, the pathological roles and mechanisms of HBc in pancreas remain to be elucidated. Methods: In present study, experimental mice were transduced with adeno-associated virus (AAV)carried plasmid of HBc cDNA via intraperitoneal injection on location of pancreas (once/a week) for 4 weeks. At end point, mice have been sacrificed, and pancreas were collected for analysis. In cell study, human beta cells, beta-TC-6, were transfected with HBc vector, and then stimulated with additional glucose for investigating insulin secretion. Results: At end point, blood glucose significantly elevated, but insulin reduced in AAV-HBc transduced mice. Immunohistochemistry showed weak cAMP, PKA and insulin, but increased fibrosis in islets of in AAV-HBc transduced mice. Similarly, HBc transfection also reduced cAMP, PKA and insulin, and induced apoptosis in beta-TC-6 cells. Conclusions: This study demonstrated HBc could interfere insulin secretion and damage islet through disrupting cAMP/PKA signaling. This result implies mechanism of chronic HBV infectionrelated pancreatogenic diabetes. 217
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PD-11
THE ROLE OF ANGIOPOIETIN-LIKE PROTEIN 4 (ANGPTL4) IN PATHOGENESIS OF GESTATIONAL DIABETES MELLITUS 1
CHUN-HENG KUO, 2SHU-HUEI WANG, 3SHIN-YU LIN, 4SZU-CHI CHEN, 5 HUNG-YUAN LI 1
Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan/School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; 2 Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan; 3 Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; 4Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan; 5Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Background: Angiopoietin-like protein 4 (ANGPTL4) is a secretory glycoprotein, which participates in the regulation of glucose homeostasis in non-pregnant subjects. However, there is currently no literature regarding the role of ANGPTL4 in glucose metabolism during pregnancy and pathogenesis of gestational diabetes mellitus (GDM). We hypothesize that obesity results in an increase of plasma free fatty acid, which stimulates expression and secretion of ANGPTL4 at placenta. ANGPTL4 is involved in pathogenesis of GDM via inducing endoplasmic reticulum (ER) stress, human placental lactogen (hPL) and growth hormone variant (GH2) at placenta, and acting as an endocrine effect to cause insulin resistance, coordinately reducing glucose uptake at peripheral tissues. Methods: We used blood and placenta samples collected previously in a pregnancy cohort for human study analyses. Besides, we used 3A-sub-E trophoblast cell lines to explore the effect of ANGPTL4 overexpression on ER stress, inflammation, and the expression and secretion of hPL and GH2. Using L6 cell lines, we investigated the mechanism of ANGPTL4 mediating insulin signaling and glucose uptake. Results: The expression of ANGPTL4 at placenta were higher in obese women than in women with normal BMI. Palmitic acid significantly induced ANGPTL4 expression in trophoblast cells. ANGPTL4 overexpression in trophoblast cells resulted in ER stress, which stimulated
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Abstract GH2 expression. ANGPTL4 suppresses insulin-mediated glucose uptake through EGFR/ERK 1/2/Akt pathway in skeletal muscle cells. Plasma ANGPTL4 levels in the first trimester were significantly higher in women with GDM than in control, were significantly associated with BMI, plasma TG and GH2 in the first trimester and negatively associated with insulin sensitivity index ISI0,120 in the second trimester, and could be a predictive biomarker of GDM. Conclusions: ANGPTL4 overexpression at placenta is involved in pathogenesis of GDM via inducing ER stress, GH2 at placenta and inhibiting insulin signaling and reducing glucose uptake at muscle cells. ANGPTL4 at early pregnancy can predict GDM.
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
PD-12
ANGIOPOIETIN-LIKE PROTEINS 8 (ANGPTL8) IN OMENTAL ADIPOSE TISSUE IS POSITIVELY ASSOCIATED WITH BMI 1
TSE-YING HUANG, 2SHIAU-MEI CHEN, 3LEE-MING CHUANG, 3YI-CHENG CHANG, 3 TIEN-JYUN CHANG 1
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; College of Medicine ,National Taiwan University Hospital, Taipei, Taiwan; 3Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 2
Obesity defined as abnormal or excessive fat accumulation that presents major risk factors for several chronic diseases, including diabetes, cardiovascular diseases and cancer. Obesity now becomes a disease that required medical involvement. BMI has been used as a tool for the diagnosis obesity, however, some important limitations of BMI were known in individuals with normal BMI but have excessive percentage of body fatness while being labeled as non-obese subject. Therefore, in addition to BMI, more obesity-related factors or biomarkers are needed as criteria for diagnosis. Angiopoietin-like proteins 8 (ANGPTL8) is a member in the ANGPTL family and as regulator in lipid metabolism. It also plays the role in beta-cell proliferation, expansion and islet function. Serum levels of ANGPTL8 in humans were correlated with improved adipose tissue lipid storage and lower serum triglyceride levels in the fed state. But it is still unclear about correlation between expression levels of ANGPTL8 in different parts of adipose tissues and metabolic parameters. The more specific mechanisms for the regulation of ANGPTL8 on lipid and glucose metabolism still need for more investigation. Our study recruited 330 human subjects, including 281 obesity subjects and 49 nonobesity subjects. We collected the residual specimens from bariatric surgery and intraabdominal surgery, all the participants had signed informed consent before enrolment. In this study, we found out that the ANGPTL8 level in omental adipose tissue is positively correlated with BMI. We also demonstrated that ANGPTL8 expression is significantly higher in the late stage of adipocytes differentiation than that in the early stage of adipocytes differentiation. Consistently, ANGPTL8 expression in omental adipose tissue is significantly higher in mice fed with high
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Abstract PD-13
IMMUNE CHECKPOINT INHIBITORS: AN EMERGING CAUSE OF INSULIN-DEPENDENT DIABETES 1
HUNG-HUI WEI, 1MIAW-JENE LIOU, 1YA-CHU CHANG, 2WEN-CHENG CHANG
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; 2Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
Background: Immune checkpoint inhibitor (ICI) therapy became a treatment choice for variant cancer and immune related adverse events have been reported frequently in recent years. Insulin dependent diabetes is a rare adverse event associated with ICIs which may present as life threatening complication such as diabetic ketoacidosis. Methods: We retrospectively reviewed 2517 patients treated with ICIs over 6 years at Chang Gung Memorial Hospital, Linkou, from 2016 to November 2021. We identified 9 patients who developed new-onset insulin dependent diabetes or diabetic ketoacidosis (DKA) related to ICIs during this period. Results: Of the 9 patients with insulin dependent diabetes, most frequently with nivolumab (55.6%), comparing to pembrolizumab (22.2%) and atezolizumab (22.2%), not with cytotoxic T lymphocyte antigen 4 inhibitors. Those that developed new-onset insulin-dependent diabetes had a median age at ICI initiation of 66.2 years old. New-onset insulin-dependent diabetes developed in 9 patients after a median of 15 cycles (range: 1-42) of ICI or 10.3 months (range: 1.5-19.8) since initiation of ICI therapy. Eighty-nine percent of the patient presented with diabetic ketoacidosis. All patients had low C-peptide level. Antibodies associated with type 1 diabetes were tested in all patients, but none of them had positive antibody including antibodies against glutamic acid decarboxylase 65, islet antigen 2. Insulin autoantibodies were all negative in seven patients while diagnosed as insulin dependent diabetes but turned positive shortly in 2/3 (33.3%) when following up within half an year. Conclusions: 221
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
Programmed cell death protein 1 (PD-1) inhibitors and its ligand (PD-L1) can lead to insulin deficiency presenting as new-onset diabetes, with a frequency of 0.36 % in all ICIs. Autoantibody testing is not definitive for diagnosis, creating the potential for misclassification. Earlier awareness of hyperglycemia and diabetic ketoacidosis is important therefore monitoring blood glucose is necessary for patient under PD-1/PD-L1 therapy.
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Abstract PD-14
OTHER TYPE OF DIABETES ASSOCIATED WITH IMMUNOTHERAPY RELATED ADVERSE EVENT: A CASE REPORT 1
YING-YU CHEN, 2HSIN-YEN CHEN, 2,3CHII-MIN HWU, 1SHIH-TZER TSAI
1
Section of Endocrinology and Metabolism, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan; 2Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 3Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
Background: Immune checkpoint inhibitors (ICI) are potent and promising immunotherapeutic agents that are increasingly used for the management of various types of advanced cancers. However, ICI-induced immune system activation could lead to autoimmune inflammation and endocrinopathy. The typical side effects of ICIs include immune-related adverse events (irAEs), affecting numerous endocrine glands. Other type of diabetes has recently been acknowledged as a potential side effect of these medications. Methods: We reported a patient underwent treatment with ICI presented with diabetic ketoacidosis and became insulin-dependent subsequently. Results: A 62-year-old, non-obese, Taiwanese male, without familial and prior history of diabetes, got renal cell carcinoma (stage Ⅲ), then received right nephrectomy and immunotherapy with pembrolizumab at TVGH. Six months later, he experienced twitching of foot, excessive thirst, frequency of urination and significant weight loss. Extreme hyperglycemia (790 mg/ dL), metabolic acidosis (venous pH 7.283, HCO3- 16.1 mmol/L), ketonuria and hyperkalemia (5.6 mEq/L) were documented, compatible with the diagnosis of diabetic ketoacidosis. His presenting HbA1c was 7.2 % and his fasting serum C-peptide was 0.32 ng/mL. Fluid therapy and IVII were initiated immediately for DKA management and shifted to multiple daily insulin injections during hospital stay at TMUH. Pembrolizumab was withdrawn, but he became insulin-dependent with follow-up C-peptide of less than 0.01 ng/mL. With brittle glycemic control and frequent hypoglycemia at home, he consulted CHGH for DSMES and fine-tuning of insulin therapy. His diabetes was eventually stabilized with insulin requirement 223
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
of 0.49 u/kg/d and HbA1C at 6.4 – 6.8 %. Without further investigation on autoantibodies, his diabetes was temporarily categorized as other type. Conclusions: In short, ICI therapy may result in endocrine adverse events. Awareness, recognition, and appropriate management throughout the course of treatment are justified.
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Abstract BP-1
EFFECT OF TIRZEPATIDE VERSUS INSULIN DEGLUDEC ON LIVER FAT CONTENT AND ABDOMINAL ADIPOSE TISSUE IN PATIENTS WITH TYPE 2 DIABETES (SURPASS-3 MRI) 1
AMALIA GASTALDELLI, 2 KENNETH CUSI, 3 LAURA FERNANDEZ LANDO, 3 ROSS BRAY, 3 BRAM BROUWERS, 3ANGEL RODRIGUEZ, 4 THOMAS LEW (NON-AUTHOR PRESENTER) 1
Cardiometabolic Risk Laboratory, Institute of Clinical Physiology, CNR, Pisa, Italy; 2Division of Endocrinology, Diabetes and Metabolism, The University of Florida, FL, USA; 3Diabetes BU, Eli Lilly and Company, Indianapolis, IN, USA; 4Diabetes BU, Eli Lilly and Company, Taipei, Taiwan, R.O.C
Objective: The effect of tirzepatide (TZP), a novel dual (GIP)/(GLP-1) receptor agonist versus (vs) insulin degludec (IDeg) on liver fat content (LFC) and volume of abdominal visceral and subcutaneous adipose tissue (VAT and SAT) was assessed in a subpopulation of patients in the SURPASS-3 study. Materials and Methods: This substudy of the open-label, Phase 3 trial included insulin-naive patients with type 2 diabetes (T2D) inadequately controlled on stable doses of metformin with/without SGLT-2i and Fatty Liver Index>60 at baseline (BL). Patients had an MRI scan performed prior to randomisation (1:1:1:1) to once-weekly TZP (5, 10, 15 mg) or once-daily IDeg. LFC and abdominal VAT and SAT volumes were assessed with MRI. Primary objective compared the change from BL in LFC at Week-52 using pooled TZP (10/15 mg) data vs IDeg. Secondary objectives compared the individual TZP doses vs IDeg at Week52 for LFC, abdominal VAT and SAT volumes; proportion of patients achieving LFC ≤10%; ≥30% relative decrease from BL in LFC. Results: 296 patients from TZP (5 mg, N=71; 10 mg, N=79; 15 mg, N=72) and IDeg (N=74) had evaluable MRI data (mean BL age, 56.2 years; T2D duration, 8.3 years; HbA1c, 67 mmol/mol (8.2%); body weight [BW], 94.4 kg; BMI, 33.5 kg/m2; 30% on SGLT-2i). At Week-52, all individual TZP doses reduced LFC from BL to a greater extent than IDeg and absolute reduction from BL in LFC was significantly greater for pooled TZP 10/15 mg arms than IDeg arm (least squares mean treatment difference [95% CI]: -4.71% [-6.72, -2.70], p<0.001). Patients achieving LFC ≤10% and those ≥30% relative decrease from BL were
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significantly greater for TZP vs IDeg. All TZP doses significantly reduced abdominal VAT and SAT while IDeg increased both. There were significant correlations between changes in LFC and HbA1c (ρ=0.31, p≤0.01), BW (ρ=0.31, p≤0.01), SAT (ρ=0.30, p≤0.01) and VAT (ρ=0.24, p<0.05) volumes, alanine aminotransferase (ρ=0.40, p≤0.001), and aspartate aminotransferase (ρ=0.25, p<0.05) in the pooled TZP 10/15 mg arms. Conclusion: TZP demonstrated clinically meaningful reduction in LFC and abdominal VAT and SAT volumes vs IDeg in patients with T2D and elevated LFC in the SURPASS-3 study.
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Abstract BP-2
EFFECT OF TIRZEPATIDE VERSUS INSULIN DEGLUDEC ON GLYCEMIC CONTROL CAPTURED WITH CONTINUOUS GLUCOSE MONITORING IN PATIENTS WITH TYPE 2 DIABETES (SURPASS-3 CGM) 1
TADEJ BATTELINO, 2RICHARD BERGENSTAL, 3ANGEL RODRIGUEZ, 3 LAURA FERNANDEZ LANDO, 3ZHENTAO TONG, 3KATELYN BROWN, 4 THOMAS LEW(NON-AUTHOR PRESENTER) 1
Faculty of Medicine, University of Ljubljana, and University Medical Center Ljubljana, Ljubljana, Slovenia; International Diabetes Center HealthPartners Institute, Minneapolis, MN, USA; 3Diabetes BU, Eli Lilly and Company, Indianapolis, IN, USA; 4Diabetes BU, Eli Lilly and Company, Taipei, Taiwan, R.O.C 2
Objective: Tirzepatide (TZP) is a novel dual GIP/GLP-1 receptor agonist in development for type 2 diabetes (T2D) treatment. This study compares the percentage of time in tight range (TITR) and to evaluate the glucose variability with continuous glucose monitoring (CGM) over 24 hours for TZP versus (vs) insulin degludec (IDeg) in a subpopulation of insulin-naïve patients with T2D inadequately controlled on metformin with/without SGLT-2i. Materials and methods: In this sub-study of the 52-week, open-label, parallel-arm, Phase 3, SURPASS-3 trial, a subset of 243 randomized patients who received at least 1 dose of study drug and had CGM data were included. Patients were randomized 1:1:1:1 to receive once-weekly TZP [5, 10, 15 mg] or IDeg once daily. Interstitial glucose values were collected by CGM at 5-minute intervals for approximately 7 days at baseline, 24 weeks, and 52 weeks. Primary objective compares pooled TZP 10/15 mg vs IDeg for the percentage of TITR for CGM glucose values (3.9 to 7.8 mmol/L) during a 24-hour period at 52 weeks. Secondary objectives compare all TZP doses vs IDeg for the percentage of TITR at 24 weeks. Results: In TZP (5 mg N=64, 10 mg N=51, 15 mg N=73) and IDeg (N=55) groups, baseline HbA1c was 8.17% (65.8 mmol/mol), 7.92% (63.1 mmol/mol), 8.31% (67.3 mmol/ mol), and 8.09% (64.9 mmol/mol), respectively, and the fasting serum glucose concentration greater TITR for CGM glucose values (3.9 to 7.8 mmol/L) than IDeg at 52 weeks (72.60 ± at 52 weeks (10 mg [p<0.05]; 5 and 15 mg [p<0.001]). All doses of TZP had significantly
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less percentage of time ≤3.9 mmol/L than IDeg at 52 weeks (10 mg [p<0.05]; 5 and 15 mg [p<0.001]). All doses of TZP significantly reduced the Within-day Coefficient of Variation vs IDeg at 52 weeks (p<0.001). Conclusion: TZP demonstrated significantly greater TITR and decreased glycemic variability measured using CGM with lower risk of hypoglycemia in comparison to IDeg.
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Abstract BP-3
CHARACTERISTICS OF PATIENTS TREATED WITH GLUCAGONLIKE PEPTIDE-1 RECEPTOR AGONISTS FOR TYPE 2 DIABETES IN TAIWAN: A REAL-WORLD STUDY 1
THOMAS LEW, 2JUI-HUNG SUN, 2SHENG-HWU HSIEH, 3JOSEFINE REDIG, 4 AHONG HUANG, 1SERENA SHAO, 5CHIA-HUNG LIN 1
Eli Lilly Taiwan, Taipei City, Taiwan; 2Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 3Eli Lilly and Company, Stockholm, Sweden; 4Tigermed-BDM, Somerset, NJ, USA; 5Chang Gung Memorial Hospital, Linkou, Taiwan.
Background: Updated Taiwanese criteria for reimbursement of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were implemented in May 2020. Patients prescribed GLP1 RAs are those with glycosylated hemoglobin (HbA1c) >8.5% who have received prior therapy with metformin and/or sulfonylureas plus dipeptidyl peptidase-4 inhibitors, sodiumglucose cotransporter-2 inhibitors, or insulin. Studying patient characteristics could improve the understanding of treatment patterns and healthcare-related utilization. Objectives: To describe baseline and clinical characteristics of type 2 diabetes (T2DM) adult patients initiated on GLP-1 RAs dulaglutide or liraglutide. Design and methods: This observational, retrospective, longitudinal, cohort study analysed real-world data from seven Chang Gung medical institutes, extracted from the Chang Gung Research Database (CGRD). Included patients were Taiwanese adults diagnosed with T2DM who initiated treatment with dulaglutide or liraglutide during the selection period (2011–2019). Descriptive statistics were used to analyse patient characteristics. Treatment patterns and healthcare-related resource use will be assessed and described in the subsequent poster. Results: Of 4,196,654 individuals in the database, 4,140 were eligible for inclusion in the analysis. Mean±SD age was 56.01±13.23 years with 52.66% being female. At baseline, mean±SD HbA1c was 9.41±1.67%, while most patients had a HbA1c value of ≥8.5% (71.10%; HbA1c <7.5% and 7.5–8.5%: 10.53% and 18.37%, respectively). Mean±SD body mass index (BMI) was 29.73±5.64 kg/m2 with 87.93% of patients classified as overweight or obese (Taiwanese BMI categories, kg/m2: <18.5: 0.40%; 18.5–23.9: 11.67%; 24.0–26.9: 229
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rd Annual Meeting of March 19-20, 2022 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)
21.28%; and ≥27: 66.65%). Mean±SD urine protein was 187.41±352.42 mg/dL, with 37.50% falling in the normal range (<30 mg/dL), 44.70% showing microalbuminuria (30-300 mg/ dL), and 17.80% showing macroalbuminuria (≥300 mg/dL). Common baseline comorbidities were hyperlipidemia (64.25%), dyslipidemia (64.13%), hypertension (55.82%), neuropathy (36.21%); ≥1 cardiovascular-related disease was present in 13.67% of patients. Conclusions: This analysis showed these Taiwanese study patients with T2DM initiated on dulaglutide or liraglutide were generally middle-aged, clinically overweight or obese, showed pathological urine protein levels, had significant comorbidities, and HbA1c of ≥8.5%. Funding: This study was funded by Eli Lilly and Company.
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