MTP 2017 ( Meet The Professor ) Endocrine Case Management

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2017 Meet-the-Professor Endocrine Case Management is your source for the H
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2055 L Street NW, Suite 600
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ENDOCRINE
SOCIETY.,J © 2017 ENDOCRINE SOCIETY
© 2017 ENDOCRINE SOCIETY
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FROM THE EXPERTS IN ENDOCRINOLOGY
ENDO 2017
MEET-THE-PROFESSOR
ENDOCRINE
CASE MANAGEMENT
END8 2017 ENDOCRINE._,
SOCIETY_,1
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ENDOCRINE
SOCIETY_,.1
2055 L Street, NW, Suite 600
Washington, DC 20036
www.endocrine.org
Other Publications:
press.endocrine.org
TheEndocrineSocietyistheworld’slargest,oldest,andmostactiveorganizationworkingtoadvancetheclinicalpracticeof
endocrinologyandhormoneresearch.Foundedin1916,theSocietynowhasmorethan18,000globalmembersacrossarange
of disciplines.
The Society has earned an international reputation for excellence in the quality of its peer-reviewed journals, educational
resources, meetings, and programs that improve public health through the practice and science of endocrinology.
Clinical Science Chair, ENDO 2017
John (Jack) Leahy, MD
Physician-In-Practice Chair, ENDO 2017
Ann Danoff, MD
Thestatementsandopinionsexpressedinthispublicationarethoseoftheindividualauthorsanddonotnecessarilyreflectthe
views of the Endocrine Society. The Endocrine Society is not responsible or liable in any way for the currency of the
information,foranyerrors,omissionsorinaccuracies,orforanyconsequencesarisingtherefrom.Withrespecttoanydrugs
mentioned,thereaderisadvisedtorefertotheappropriatemedicalliteratureandtheproductinformationcurrentlyprovidedby
themanufacturertoverifyappropriatedosage,methodanddurationofadministration,andotherrelevantinformation.Inall
instances,itistheresponsibilityofthetreatingphysicianorotherhealthcareprofessional,relyingonindependentexperience
and expertise, as well as knowledge of the patient, to determine the best treatment for the patient.
Copyright©2017bytheEndocrineSociety,2055LStreet,NW,Suite600,Washington,DC20036.Allrightsreserved.No
partofthispublicationmaybereproduced,storedinaretrievalsystem,postedontheinternet,ortransmittedinanyform,by
any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher.
RequestsforpermissionforreproductionshouldbedirectedtotheEndocrineSocietyPublicationsDepartment:http://www.endo-
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contactSocietyServicesbytelephoneat202-971-3646,faxat202-736-9704,[email protected]
onlinestore: www.endocrine.org/store.
ISBN: 978-1-879225-32-9
eISBN: 978-1-879225-34-3
Library of Congress Control Number: 2017932571
ENDO2017 · CONTENTS iii
ENDO 2017
CONTENTS
DISCLOSURE INDEX ........................................................................... iv
FOREWORD ...................................................................................... v
TOPIC INDEX ................................................................................... vi
SPEAKER HANDOUT INDEX .................................................................. xi
ADRENAL/HPA AXIS .......................................................................... 1
BONE, CALCIOTROPIC HORMONES, AND VITAMIN D .................................. 33
DIABETES AND GLUCOSE METABOLISM ................................................. 59
GENERAL ENDOCRINOLOGY .............................................................. 111
NEUROENDOCRINOLOGY AND PITUITARY ............................................. 141
OBESITY AND LIPIDS ...................................................................... 177
PEDIATRIC ENDOCRINOLOGY ............................................................ 203
REPRODUCTIVE ENDOCRINOLOGY ...................................................... 233
THYROID/HPT AXIS ........................................................................ 279
iv ENDO2017 · DISCLOSUREINDEX
ENDO 2017
DISCLOSURE INDEX
Thefaculty,committeemembers,andstaffwhoareinpositiontocontrol Consultant,ONO-Pharma.Leffert,J:StudyInvestigator,AbbottLaboratories,
thecontentofthisactivityarerequiredtodisclosetotheEndocrineSociety Bristol-MyersSquibb,Merck&Co.,AstraZeneca,RocheDiagnostics,Novo
and to learners any relevant financial relationship(s) of the individual or Nordisk,Sanofi.Mannstadt,M:AdvisoryGroupMember,Shire.Mauras,N:
spouse/partner that have occurred within the last 12 months with any PrincipalInvestigator,Pfizer,Inc.,Orphan;AdvisoryGroupMember,OPKO.
commercialinterest(s)whoseproductsorservicesarerelatedtotheCME McGill,J:AdvisoryGroupMember,JansenPharmaceuticals,Merck&Co.,
content.Financialrelationshipsaredefinedbyremunerationinanyamount Novo Nordisk, Calibra,Dynavax,Intarcia; Principal Investigator, Novartis
from the commercial interest(s) in the form of grants; research support; Pharmaceuticals, Lexicon Pharmaceuticals, Inc.; Speaker, Jansen Pharma-
consulting fees; salary; ownership interest (e.g., stocks, stock options, or ceuticals; Committee Member, Boehringer-Ingelheim; Ad Hoc Consultant,
ownershipinterestexcludingdiversifiedmutualfunds);honorariaorother Dexcom.Merke,D:PrincipalInvestigator,Diurnal,MillendoTherapeutics.
paymentsforparticipationinspeakers’bureaus,advisoryboards,orboards Molitch, M: Ad Hoc Consultant, Abbott Laboratories; Owner, Amgen;
ofdirectors;orotherfinancialbenefits.Theintentofthisdisclosureisnotto Investigator, Bayer, Inc., Novartis Pharmaceuticals, Novo Nordisk, Ipsen,
preventCMEplannerswithrelevantfinancialrelationshipsfromplanningor Johnson & Johnson; Advisory Group Member, Jansen Pharmaceuticals;
delivery of content, but rather to provide learners with information that MemberofAdvisoryCommitteesorReviewPanels,Merck&Co.,Pfizer,Inc.
allows them to make their own judgments of whether these financial re- Peters,A:AdHocConsultant,AbbottLaboratories,EliLilly&Company,
lationships may have influenced the educational activity with regards to Merck&Co.,NovoNordisk,Sanofi,MedtronicMinimed;SpeakerBureau
expositionorconclusion. Member,EliLilly&Company,NovoNordisk;Speaker,RocheDiagnostics;
Investigator,Dexcom.Rosenthal,S:Consultant,ABBVIE,INC.Salvatori,R:
TheEndocrineSocietyhasreviewedalldisclosuresandresolvedormanaged AdvisoryGroupMember,NovoNordisk,ionis;AdHocConsultant,Pfizer,
allidentifiedconflictsofinterest,asapplicable. Inc. Santoro, N: Principal Investigator, Bayer, Inc.; Ad Hoc Consultant,
Menogenix. Schwartz, A: Advisory Group Member, Amgen. Siraj, E:
Thefollowingfacultyreportedrelevantfinancialrelationship,asidentified Consultant, GlaxoSmithKline. Terzolo M: HRA Pharma; Advisory Group
below:Azziz,R:AdHocConsultant,Bayer,Inc.,JDSTherapeutics;Advisory Member,Atterocor.Verbalis,J:AdHocConsultant,FerringPharmaceuticals,
GroupMember,GlobalPETImaging.Bessesen,D:DataSafetyMonitoring Otsuka.WeltC:Speaker,NovartisPharmaceuticals.Wysham,C:Speaker,
BoardMember,EnteromedicsInc.Brown,T:Consultant,Gilead,Merck& AstraZeneca,EliLilly&Company,JansenPharmaceuticals,NovoNordisk,
Co.,Bristol-MyersSquibb,EMDSerono,Theratechnologies.Cabanillas,M: Sanofi, Boehringer-Ingelheim; Advisory Group Member, Sanofi, Novo
Consultant, Eisai. Advisory Group Member, LOXO. Dad-u,-R: Advisory Nordisk; Consultant, Jansen Pharmaceuticals, Novo Nordisk, Sanofi; Sci-
Group Member, Bristol-Myers Squibb. Econs, M: Inventor, Kyowa Hakki entificBoardMember,JansenPharmaceuticals.Young,W:Consultant,Nihon
Kirin Pharma. Eugster, E: Principal Investigator, Endo Pharmaceuticals; Medi-Physics.Zeitler,P:Consultant,DaiichiSankyo,Merck&Co.,Takeda,
Study Investigator, Astra Zeneca, Eli Lilly & Company, Tolmar Orphan JansenPharmaceuticals,Boehringer-Ingelheim.
Reach. Fleseriu, M: Principal Investigator, Ad Hoc Consultant, Novartis
Pharmaceuticals, Chiasma, Pfizer Global R&D. Garg, A: Consultant, The following faculty reported no relevant financial relationships:
Aegerion Pharmaceuticals, Inc.; Study Investigator, Aegerion, Principal Anawalt,BD;Balasubramanian,R;Baron,J;Becker,C;Brent,G;Cappola,A;
Investigator, Ionis Pharmaceuticals, Inc., Intercept Pharmaceuticals, Inc., Carlson, HE; Chen, H; Christ-Crain. M; Colao, A; Collazo-Clavell, ML;
Kadmon Pharmaceuticals, Inc.; Consultant, Ionis Pharmaceuticals, Inc. DiMeglio,LA;Doherty,G;El-HajjFuleihan,G;Else,T;Grossman,A;Han,J;
Akcea Pharmaceuticals, Inc. Goldberg, A: Investigator, Amarin, Genzyme Jonklaas,J;Katznelson,L;Kellogg,TA;Kirk,SE;Klonoff,D;Lipska,K;
Corporation, ISIS/IONIS, Amgen, Madrigal, Pfizer, Inc. Genentech, Inc., McCall, AL; McCartney, C; Newman, C; Nickolas, T; Rosen, CJ; Safer, J;
GlaxoSmithKline,Merck&Co.,Sanofi,Regeneron;Editor,MerckManual; Speiser,PW;Tannock,LR;Timmers,JLM;Torpy,DJ;Tuttle,RM;Weber,TJ.
Advisory Group Member, Regeneron, UniQure, Consultant, OptumRX.
Korbonits, M: Principal Investigator, Teacher, Advisory Group Member; EndocrineSocietystaffreportnorelevantfinancialrelationships.
ENDO2017 · FOREWORD v
ENDO 2017
FOREWORD
Intoday’sdemandingandrapidlychanginghealthcareenvironment,finding
thetimetokeepabreastofthelatestendocrinecasemanagementstrategies
and state-of-the-art treatments has become increasingly difficult. The
Meet-The-Professor Endocrine Case Management book is designed to
provide physicians with a concise and high-quality review of over 60
commonandrareendocrinedisorderstohelpyoukeepyourpracticecurrent.
Thecontributorsofthisbookareexpertsintheirrespectivefieldsandhave
been selected for their deep understanding of the topic, their clinical ex-
perience, and their ability to clearly communicate complex information.
Thebookutilizesacase-basedformattofacilitateanenjoyablelearning
experienceandhelpsolidifyretentionoflessonslearned.Eachcontributor
hasprovidedlearningobjectives,aconciseup-to-datereviewoftheirtopic,
aswellasasummaryofcasesfollowedbyabriefdiscussionofthecasesfor
your edification. This format promotes active learning by enhancing your
knowledge of clinical endocrinology, and challenging you to apply that
knowledge to the cases included in the following pages, which mirror the
patients we see daily in the office and the hospital.
We thank the many experts who have shared their vast knowledge and
insightsinthelivesessionsandthisaccompanyingbook,whichalsoserves
as a wonderful resource for sessions that you may have been unable to
attend. We are also grateful for the Endocrine Society staff whose efforts
were instrumental to the successful publication of this book.
Ann Danoff, MD
Physician-In-Practice Chair, ENDO 2017
Philadelphia Veterans Affairs Hospital
Philadelphia, Pennsylvania
John (Jack) Leahy, MD
Clinical Science Chair, ENDO 2017
University of Vermont, College of Medicine
Colchester, Vermont
vi ENDO2017 · TOPICINDEX
ENDO 2017
TOPIC INDEX
ADRENAL/HPA AXIS
M01 – Adrenal Incidentalomas Page 2
Massimo Terzolo, MD
M02 – Attenuated Congenital Adrenal Hyperplasia Page 8
Deborah P. Merke, MS, MD
M03 – Diagnosis and Management of Pheochromocytoma/Paraganglioma Page 11
Henri J.L.M. Timmers, MD, PhD
M04 – Diagnosis and Treatment of Adrenal Insufficiency Page 19
David J. Torpy, FRACP
M05 – Primary Aldosteronism: What Is New and Clinically Relevant? Page 29
William F. Young, Jr., MD, MSc
BONE, CALCIOTROPIC HORMONES, AND VITAMIN D
M06 – Bone Health in Patients With Cancer Page 34
Carolyn Becker, MD
M07 – Challenges in DXA Interpretation: Do Expect Anomalies Page 38
Thomas J. Weber, MD
M08 – Hypocalcemia Page 43
Clifford J. Rosen, MD
M09 – Hypoparathyroidism Page 47
Michael Mannstadt, MD
M10 – Hypophosphatemic Disorders Page 50
Michael J. Econs, MD
M11 – Osteoporosis Treatment Failure, Change of Therapy, and Drug Holidays Page 54
Ghada El-Hajj Fuleihan, MD, MPH
DIABETES AND GLUCOSE METABOLISM
M13 – Comorbidities in Diabetes and Cardiovascular Disease Page 60
Janet B. McGill, MD
M14 – Diabetes and Metabolic Bone Health Page 63
Ann Schwartz, PhD
ENDO2017 · TOPICINDEX vii
M15 – Continuous Glucose Monitoring Page 66
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE
M16 – Diagnosis and Management of Diabetes in Pregnancy Page 71
Susan E. Kirk, MD
M17 – Diagnosis and Management of Diabetic Neuropathies Page 76
Aaron I. Vinik, MD, PhD, FCP, MACP, FACE
M18 – New Insulins and New Combinations Page 86
Carol H. Wysham, MD
M19 – Goals of Diabetes Care in the Oldest of the Old Page 91
Kasia J. Lipska, MHS
M20 – How To Be a Change Agent Page 95
Ann Peters, MD
M21 – Hypoglycemia Page 98
Anthony L. McCall, MD, PhD
M22 – Posttransplantation Diabetes Mellitus Page 106
Elias S. Siraj, MD, FACP, FACE
GENERAL ENDOCRINOLOGY
CMF1 – Endocrine Tumor Genetics: Challenging Issues Page 112
Tobias Else, MD and Ma´rta Korbonits, MD, PhD
M23 – Endocrine Immune-Related Adverse Events Page 123
Ramona Dadu, MD
M24 – Challenging Patients: Hey Doc, Something Is Wrong With My Glands Page 127
Jonathan D. Leffert, MD, FACP, FACE, ECNU
M25 – Growth Hormone Therapy in Adults: Getting It Right! Page 129
Annamaria Colao, MD, PhD
M27 – HIV and Endocrine Disorders Page 135
Todd T. Brown, MD, PhD
NEUROENDOCRINOLOGY AND PITUITARY
M28 – Diagnosis and Management of Diabetes Insipidus Page 142
Mirjam Christ-Crain, MD, PhD
M29 – Diagnosis and Management of Hyponatremia Page 147
Joseph G. Verbalis, MD
M30 – Diagnosis and Management of Prolactinoma Page 156
Mark E. Molitch, MD
viii ENDO2017 · TOPICINDEX
M31 – Medical Management of Acromegaly: An Update Page 160
Maria Fleseriu, FACE
M32 – Metastatic Neuroendocrine Tumors Page 167
Ashley B. Grossman, MD
M33 – Perioperative Management of Pituitary Tumors Page 171
Roberto Salvatori, MD
OBESITY AND LIPIDS
CMF5 – Care of the Post–Bariatric Surgery Patient: The Good, the Bad, and the Ugly Page 178
Maria L. Collazo-Clavell, MD
M34 – Appropriate Use of PCSK9 Monoclonal Antibodies Page 181
Anne Carol Goldberg, MD
M36 – Lipid Disorders in Women Page 184
Lisa Tannock, MD
M37 – Lipodystrophy Syndromes Page 188
Abhimanyu Garg, MD
M38 – Statin Intolerance Page 193
Connie B. Newman, MD
PEDIATRIC ENDOCRINOLOGY
M41 – CAH in the Pediatric Patient Page 204
Phyllis W. Speiser, MD
M42 – Management of Precocious Puberty: Questions and Considerations Page 208
Erica A. Eugster, MD
M43 – Short Stature Page 213
Jeffrey Baron, MD
M44 – Treating Toddlers: Care of Preschool Children With Type 1 Diabetes Page 217
Linda A. DiMeglio, MD, MPH
M45 – Turner Syndrome: A Focus on Growth, Puberty, and Fertility Page 221
Nelly Mauras, MD
M46 – Youth-Onset Type 2 Diabetes Page 228
Philip Zeitler, MD, PhD
REPRODUCTIVE ENDOCRINOLOGY
CMF3 – Case Management Forum: Polycystic Ovary Syndrome Page 234
Christopher R. McCartney, MD and Corrine K. Welt, MD