Top lessons learned from ENDO 2015

The Endocrine Society’s Scientific Sessions were packed with groundbreaking, potentially practice-changing studies, offering everything from examining the specific pathways in the brain that control eating behavior to the benefits of menopausal hormone therapy outweighing the risks for those just entering menopause.

As the buzz generated at the meeting continues to reverberate throughout the endocrinology community, Endocrine Today asked experts to discuss the key lessons they took away from the meeting.

Lesson 1: Physiologic mechanisms in obesity are becoming clearer.

Richard J. Santen, MD, Endocrine Society’s 2014-2015 President

“The plenaries were an outstanding feature of the program. One area specifically noted was the science involved in several areas regulating body weight and likely etiologically related to obesity. Stephen O’Rahilly, MD, of Cambridge, United Kingdom, has identified mutations of several genes in the brain that control obesity and satiety. These studies involve a technique called genome-wide association studies (GWAS). He uses this analysis to compare thin subjects with severely obese subjects and identifies single nucleotide polymorphisms (SNPs). The fact that a large percentage of these SNPs are involved with regulation of appetite and satiety suggests that an important component of obesity may be physiologic dysregulation of appetite and satiety genes. The SNPs are likely to ultimately provide steps for which one can develop drugs to intercept. This plenary was followed later by one examining the specific pathways in the brain that work in a fashion analogous to electrical wiring to control eating behavior. This was presented by Bradford Lowell, MD, of Boston. Taken together, these two plenaries indicate that obesity is not just a behavioral problem of eating too much, but results from abnormalities of specific control pathways. For the future, this is exceedingly important as it provides directions for drug development.”

Lesson 2: Personalized medicine benefits women with menopause symptoms

Richard J. Santen, MD, Endocrine Society’s 2014-2015 President

“The two plenaries on menopause and its management and the presentation of clinical guidelines on menopause provided new insights into this common problem. It is clear from the presentations that the benefits of menopausal hormone therapy outweigh the risks for women just entering menopause who have symptoms and no contraindications. The data presented provided a compelling example of the power of precision medicine and of personalized medicine. These two examples — obesity and menopause — demonstrate the relevance and scientific importance of the information presented in the plenary sessions and highlight what most commenters mentioned about ENDO 2015.”

Lesson 3: The FDA is your friend.

Richard J. Santen, MD, Endocrine Society’s 2014-2015 President

“The talk by Janet Woodcock, MD, provided a look from inside the FDA at what is necessary for the approval of new drugs for diabetes. She used the example of rosiglitazone (Avandia, GlaxoSmithKline) to describe how the FDA came up with methodology to assess the cardiovascular effects of diabetes drugs. Rosiglitizone was thought to have adverse cardiovascular effects but ultimately was shown to be relatively safe in this regard. To demonstrate safety, large studies had to be conducted as the cardiovascular risk signal was small. The information gained from this process has educated endocrinologists about the effect of anti-diabetes drugs on the cardiovascular system. Woodcock recently received a lifetime achievement award for her work at the FDA, and her long experience with the drug approval process was apparent in her talk. The large group of endocrinologists who attended her presentation gained insight into this important process.”

Lesson 4: We have more to learn about endocrine function during critical illness.

Stephen A. Brietzke, MD, Endocrine Today Editorial Board member

“One of the most informational things from our meeting was the session on critical care endocrinology. As usual, Greet Van den Berghe, MD, PhD, did not disappoint. She gave an excellent presentation on the acute and long-term physiology of adrenal function in the critically ill. We learned from her presentation that the concept of relative adrenal insufficiency during the early phase of critical illness is probably incorrect. We learned that ACTH levels actually go down during this phase of illness, but we also learned that the metabolic degradation of cortisol likewise goes down. We also learned that after prolonged critical illness (3-4 weeks or longer), there actually is atrophy of the cortisol-producing adrenal cortex, so there may well be a late adrenal exhaustion that may be clinically significant. We'll need to stay tuned for more on this topic.”

Stephen A. Brietzke

Lesson 4: Technology for evaluating indeterminate thyroid lesions is improving.

Jerome M. Hershman, MD, Endocrine Today Editorial Board member

“Thyroid nodules in the FNA categories of follicular lesion of undetermined significance and follicular neoplasm pose a challenge in management. If they are sent for diagnostic lobectomy, the incidence of thyroid cancer is at most about 30% at pathologic examination. To improve this situation, a panel of 7 oncogenes can be measured on the FNA. This has a sensitivity for diagnosis of cancer of about 85%, but it does not have satisfactory negative predictive value. At ENDO 2015, Interpace Diagnostics presented data on 109 FNA samples in these indeterminate categories studied prospectively by a new method that involved the oncogene panel plus measurement of 10 microRNAs. The surgical outcome resulted in 35 differentiated cancers and 74 benign lesions. The FNA from the 35 cancers tested positively for either the oncogene mutations or the miRNA, yielding a sensitivity of 89%. The FNA of 63 of the 74 benign lesions tested negative by both tests. The negative predictive value was 94%.The method represents a significant advance for evaluation of these indeterminate lesions on FNA.” - by Jennifer Southall

Disclosure: Hershman reports no relevant financial disclosures.