Meeting Highlights from AACE 27th Annual Scientific & Clinical Congress

May 16-20, 2018
John B Hynes Veterans Memorial Convention Center
900 Boylston Street
Boston, MA

Charting the future was the theme of the  American Association of Clinical Endocrinologists (AACE) 2018 annual meeting, which took place in historic Boston, Massachusetts, drawing speakers from the top universities and hospitals including Harvard Medical School, Mass General Hospital, Joslin Diabetes Center, Brigham and Women's Hospital, and Beth Isreal Deaconess Medica Center.

The meeting attracted more than 3390 attendees from across the United States and many countries around the world who benefited from 66 clinically relevant sessions,500 poster abstracts and presentations, and 104 exhibitors over five days. Advances in research were shared so clinicians would learn the best strategies and management solutions for a myriad of endocrine diseases both the common and rarer disorders as well as technology updates and translational therapies. 

A record-breaking number of endocrinologists attended 27th annual AACE meeting.

The pre-congress symposia on thyroid cancer: a practical update, management of diabetes as a cardiovascular disease, and Use of diabetes technology: problem-solving in real-world settings filled the rooms.

The most popular sessions included:

  • the Thursday morning plenary on Cushing's Syndrome presented by Beverly MK Biller, MD, professor of medicine at Harvard Medical School and a neuroendocrine specialist at Massachusetts General Hosptial.
  • New Insights into Thyroid Hormone Action
  • New Dimensions in Insulin Action
  • Thyroid Cancer
  • Beta Cell Regeneration was the plenary topic presented by Andrew F. Stewart, MD, professor of medicine and director of the Diabetes, Obesity and Metabolism Institute at the Icahn School of Medicine at Mount Sinai in New York City.
  • Cardiovascular disease and diabetes:  implications for CVOTs in diabetes care, and should CVOT impact management while managing  hyperglycemia,
  • Addressing the Current and evolving approaches for osteoporosis treatment

Topics reported in-depth by EndocrineWeb are as follows:

Thyroid Diseases in Pregnancy: Hot Button Issues 

Erik K. Alexander, MD, a professor of medicine and recognized international authority on thyroid disease in pregnancy presented a comprehensive overview of the emerging data that may invite changes to treatment for hypothyroidism as well as Grave's disease (hyperthyroidism).  

The upper limit of the range for TSH appears to be moving higher to at least 4.0 mIU/L and considering the thyroperoxidase antibodies (TPOAb) levels in women seeking pregnancy or newly pregnant as this may predict pregnancy outcome.

With regard to management of hyperthyroidism, in particular, Grave's disease, in women who are pregnant, the urgency to discontinue both antithyroid drugs, propylthiouracil (PTU) and methimazole (MMI), due to their conferring an increased risk of fetal birth defects and compromised cognition (ie, IQ, ADHD), particularly early in the pregnancy. 

Also, evidence of the timing of treatment during the pregnancy as well as the variability of thyroid stimulating hormone levels among ethnicities are drawing attention and challenging the current best practices for treatment.

Evolving Management of Benign Thyroid Nodules 

Two experts shared new thinking in the assessment and management of thyroid nodules based on the likelihood of malignancy, and the ability to lessen the need for active surveillance  of benign nodules that appears to enhance detection of nodules that are most likely malignant, 

In reporting on a retrospective trial of patients undergoing fine needle aspiration biopsy of their thyroid nodules, the location within the thyroid gland, according to Fan Zhang, MD, PhD, offers a compelling argument for making a diagnosis of cancer when the informed by ultrasonography.

Given that most thyroid nodules are benign, Stephanie Lee, MD, PhD, made a strong case for clinicians to accept the need for an individualized, risk-based approach as the best way for patients to receive the best, least intensive management. 

She discussed characteristics of goiters and nodules in the thyroid gland to distinguish the rare instance of malignancy, and then plotted a method of assessment to lessen the need for active surveilance—repeat imaging studies—when monitoring for growth will suffice for the vast majority of patients. She challenged all endocrinologists to review their patients' imaging scans so that your recommendations will be directly informed rather than passing through an anonymous report from an imaging tech and the radiologist. These experts should guide your  decisions but are not a substitute when working with your patient in devising a medical management plan.

Two Endocrinologists in Attendance share their Ah-Ha Moments

Two attendees, a mother-daughter pair of endocrinologists from New Jersey, were asked about what they learned from the sessions they attended. For those unable to come to Boston (and even those of you who did), Maya P. Raghwanshi, MD, and Anita P. Raghwanski, MD, share several important insights that will inform their practices going forward and we think will be applicable to your practices as well.

The effect—both positive and negative—of dietary supplements arose in poster presentations and a clinical session. A compelling argument was made for clinicians to treat artificial sweeteners just as we do cigarettes. While one attendee challenged the making a global recommendation against the whole class of sugar substitutes since the function and properties differ, the data suggesting long-term adverse effects was hard to argue against. The findings suggest the likelihood of dose-response to weight gain in those who lean on artificial sweeteners in their daily diet. People at risk for or diagnosed with diabetes should avoid soda/soft drinks with sugar or sugar substitutes given the real risk for metabolic diseases, period. 

Not surprising, the topic of microvascular disease was a prominent topic with the takeaway message to urge for early, aggressive treatment in the pediatric population to lessen long-term complications. Hence, our presentation overview highlighting  Dr. Garvey's challenge for all endocrinologists to make a commitment to better, more regular use of pharmacotherapeutic agents for obesity.

For Anita, how she will manage patients with gastroparesis will change after she attended a session on autonomic imbalance by Aaron Vinik, MD, PhD. And, she will be more likely to recommend alpha lipoic acid to overweight patients with diabetic neuropathy because of its advantageous side effect in inducing weight loss.

Given the fast pace of change in the diabetes device sector, of greatest interest to her was the session on advances in diabetes technology. While it was of value to learn about the differences in devices options, what really mattered were the changes in device reports and a move away from hemoglobin A1c and toward the need to focus on "time-in-range," which has become possible with the use of continuous glucose monitoring devices.

She also learned a little-known reason for a "false low" Hb A1c reading. See her comments for the answer, and that the target range for serum glucose levels is changing.

The Urgency to Manage Patients with Obesity Grows

In a session on Obesity-Focused Pharmacotherapy: Giving your patients what they need, Scott Isaacs, MD, reported on this presentation by W. Timothy Garvey, MD, director of the Diabetes Research Center at the Universty of Alabama at Birmingham, and an internationally-regarded nutrition expert. Acknowledging that clinicians are faced with patients' wish for a quick fix, a miracle pill, to solve their endless suffering with obesity.

But first, he revisited the need to redefine the disease of obesity to help clinicians and the public get beyond the stigma so addressing this cardiometabolic challenge could be addressed with the same urgency as heart disease, thyroid conditions, and cancer.

To guide clinicians in tackling patient resistance to medication management, Dr. Garvey introduced four strategies to made pharmacotherapy a more successful experience for all concerned. 





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First Article From This Meeting:
Addressing the Complexity of Thyroid Disease Management During Pregnancy
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