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Issue 35 Winter 2017/18
ESE News
The newsletter of the European Society of Endocrinology
ISSN 2045-1563 (print)
ISSN 2045-1571 (online)
Barcelona 2018:
ECE welcomes you!
Also in this issue
Brexit: in your own words
New ESE guideline for aggressive
pituitary tumours
CONTENTS & EDITORIAL
In this issue Editorial
Society News I am warmed by the
thought of travelling to
03 ECE 2018 welcomes you to Barcelona the Mediterranean coast
04 Other meeting reviews and news in May, to spend time with
colleagues from around
the world and catch up on
ESE Committees endocrinology. I hope you
05 EYES looks forward to ECE 2018, plus too are already making
Gonadotrophins in Modena plans to be at ECE 2018 in
Barcelona, Spain.
13 Patient associations need your support
This issue of ESE News reminds
us of the wide breadth of our
Features discipline, which will all be on
show at the Congress. Turn to
06 Brexit: in your own words pages 8–9, where Programme
08 Sensational science at ECE 2018 Organising Committee Chair Márta Korbonits and co-Chairs Barbara
Obermayer-Pietsch and Raúl Luque have picked out many highlights
10 A passion for endocrinology – for you. These include snapshots of the talks we will enjoy from three
The Endo Explorer visits Córdoba, Spain of our award lecturers: Christos Mantzoros (Geoffrey Harris Award),
Filip Knop (European Journal of Endocrinology Award) and Philippe
Chanson (Clinical Endocrinology Trust Award).
Editor’s Selection Our colleagues in Spain have a reputation for excellence in
endocrinology. Their passion for our discipline is equally evident, as
12 New ESE guideline for aggressive Justo Castaño demonstrates in his ‘research tour of Córdoba’, on pages
pituitary tumours 10–11. On page 14, we are proud to feature the impressive life’s work
of Gabriella Morreale de Escobar of Madrid, one of ESE’s first Honorary
Members. Her son, the endocrinologist Héctor Escobar-Morreale,
At the Back... provides a personal and touching insight into her work. The University
of Santiago de Compostela is also a hive of activity. Here, translational
14 Love, respect and admiration: we salute the endocrinologist Clara Alvarez lets us have a glimpse at a day in her
work of Gabriella Morreale de Escobar very busy life (page 15).
15 A day in the life of Clara Alvarez, On pages 12–13, we are reminded that ESE itself is also very busy
and productive, as Gérald Raverot examines the development of the
translational endocrinologist Society’s new and valuable clinical guideline on aggressive pituitary
16 Endo Prize Puzzle, plus ESE diary dates tumours. Also on page 13, Jérôme Bertherat encourages us to support
patient associations so that they, in turn, may support the exciting
new Endo-ERN – the European Reference Network for rare endocrine
conditions.
This document is available on the ESE Editor: Brexit, the unfortunately painful process surrounding the UK’s
website, www.ese-hormones.org Wouter de Herder, The Netherlands
Email: w.w.deherder@erasmusmc.nl
departure from the EU, rumbles on. This inevitably affects a number
ESEndocrinology of ESE members, and we are pleased to be able to give them space to
Co-Editor:
voice their thoughts (pages 6–7). ESE would like to hear the views of
AJ van der Lely, The Netherlands
EuropeanSocietyofEndocrinology
Email: ese.president@ese-hormones.org a wide selection of its members on this subject, and we encourage
you to write to us with your perspective. By its very nature, science
The addresses used to mail this issue of Editorial Board:
ESE News were supplied by the member Justo Castaño, Spain
transcends borders, and we as a Society will continue to support
societies of ESE and are stored in Ljiljana Marina, Serbia science and scientists through this period of change.
Bioscientifica’s database for future use. If Hans Romijn, The Netherlands It is in the spirit of support for our discipline and ourselves that we
you do not wish to receive further mailings, Ayse Zengin, UK/Australia look forward to ECE 2018, and prepare to share our science. Do please
please advise info@euro-endo.org
Sub-Editor: Caroline Brewser remember to submit your abstracts by the imminent deadline of 29
©2017 European Society of Endocrinology Design: Qube Design Associates
January, and to take advantage of the early bird registration deadline
The views expressed by the contributors of 6 April.
Website: www.ese-hormones.org
are not necessarily those of ESE I look forward to seeing you all in Barcelona.
ESE would like to thank its Corporate
Members for their continued support:
Aegerion Pharmaceuticals, Eli Lilly,
Ipsen, Laboratoire HRA Pharma, Merck,
Novartis Pharmaceuticals, Novo
Nordisk, Pfizer, Sandoz International
GmbH, Shire, Strongbridge AJ van der Lely
ESE President Cover image: Mosaic detail from
Co-Editor of ESE News Gaudí’s Parc Güell, Barcelona. © iStock
2
SOCIETY NEWS
Key dates
From the
Abstract deadline:
29 January 2018
Early bird registration deadline:
6 April 2018
ESE Office
With a strong focus on
See www.ece2018.org our strategy ‘to provide
continuous endocrine-related
education and training for
all career stages in clinical
practice and basic research’,
ESE was delighted to publish
its curriculum on clinical
endocrinology, diabetes and
metabolism a few months ago
(see www.ese-hormones.
org/education). We will also
soon launch a pan-European
examination with UEMS, which
can be taken at any Pearson
Vue centre across Europe.
These initiatives sit alongside
ESE’s well respected courses.
Our next task is to bring
these activities together, to
demonstrate their ability to
underpin endocrine education
at all stages. We aim to cover
Let Barcelona
the full curriculum in a number
of courses, over a limited
time period, and to make
this as accessible as possible.
welcome you!
Online provision could allow
endocrinologists everywhere
to benefit. We will also take the
curriculum into consideration
across all our activities, ‘sign-
posting’ events which cover
different topics.
20th European Congress of Endocrinology Effective coverage of the
curriculum is a substantial
19–22 May 2018 project. We are very much
at the planning stage (and
dependent on funding
The beautiful and exciting city of Barcelona has a long history; the area was already occupied considerations), but the
when the Romans arrived here 2000 years ago. Since then, it has grown to be the second largest Education Committee (chaired
city in Spain, and is the capital of Catalonia. by Camilla Schalin-Jäntti,
Finland) and the ESE team
Amongst the best known of Família. Barcelona has strong A truly exceptional Congress are highly motivated to make
the city’s universities are the links with artists such as Pablo such as ECE 2018 deserves an real progress over the next
University of Barcelona in the Picasso (1881–1973), Salvador exceptional space. Barcelona’s 12 months.
city centre (founded 1450) and Dalí (1904–1989) and Joan Miró International Convention Centre We want to consider a
the Autonomous University (1893–1983). (CCIB), designed by the famous range of views, and two
of Barcelona (founded 1968), Others may be more familiar Catalan architect Josep Lluís sessions in November (with
located about 20km to the north. with Barcelona’s sporting Mateo, maximises the use of early career endocrinologists
There are a number of teaching associations: particularly the natural light. It has an enormous at Endobridge, Turkey, and
hospitals, and the city has an very successful FC Barcelona and exhibition hall and the banqueting with our Affiliated Societies
impressive reputation in the the 1992 Olympic Games which hall provides spectacular views of at the ESE Council of
medical sciences. were held in the city. the Mediterranean Sea. Nearby, Affiliated Societies meeting,
One of Europe’s great cultural Barcelona is a Mediterranean several comfortable hotels Serbia) sought feedback on
centres, Barcelona is renowned city open to people and to the will provide you with ample, how ESE can best provide
for its unique blend of historical world. It has a unique, vibrant convenient accommodation. support. Thank you to everyone
tradition, modernist architecture, atmosphere and almost perfect There is no better place to hold who has taken part – there are
museums and art galleries, music climate. You can easily reach our upcoming event, and it is sure exciting times ahead!
concerts and other performances Barcelona by direct flights to its to make ECE 2018 a resounding
– as well as its rich gastronomy. international airport from many success. Helen Gregson
Antoni Gaudí (1852–1926), locations. The integrated local We look forward to welcoming Chief Executive Officer, ESE
Spain’s most famous architect, public transport system includes you to Barcelona in 2018! helen.gregson@
designed many of the city’s the metro, buses, trams and ese-hormones.org
landmarks, including the Sagrada local trains.
3
SOCIETY NEWS
Ion channels in ESE Postgraduate Training
hormonal homeostasis Course in Ukraine
Mont Sainte Odile, France, 4–7 October 2017 Lviv, Ukraine, 5–7 October 2017
The 21st ESE Postgraduate
The 42nd Symposium on Hormones and Cell Regulation (ESE) Training Course on Endocrinology,
was attended by 90 scientists from across Europe and the USA. Diabetes and Metabolism was
held in October, taking place
The symposium focused on World-leading experts for the first time in Ukraine. The
‘Ion channels in hormonal attended, and there was ample host city Lviv is a historic centre,
homeostasis: transient receptor time for discussion. Most of the with many higher education
potential channels and calcium younger researchers presented establishments and important
signalling’. These channels their results in short talks and cultural institutions.
constitute, along with the posters. The meeting was a great Almost 200 attendees came
G protein complex, receptor scientific success. Participants from across Ukraine and further
tyrosine kinases, receptor also enjoyed the surroundings afield, as far as Asia and Africa.
channels and nuclear receptors, and views of the Rhine valley. The programme consisted of
one of the major types of We thank the organisers Veit plenary lectures, meet-the-
receptor which enable our cells Flockerzi (Homburg, Germany), expert parallel sessions and
to respond to external hormonal, Thomas Guderman (Munich, a very important session presenting cases submitted by local
chemical and physical signals, Germany) and Ulrich Boehm participants. This covered several difficult cases, which were widely
and thus to react to physiological (Homburg, Germany), and also discussed. Many comments from the Chairs and the audience
and pathological situations. ESE and the other sponsors: the suggested further management proposals. This illustrated some
More than 30 of these Leopoldina (Halle, Germany), difficulties in endocrine diagnostics and therapy at a local level.
receptors are known. They TRR152 (Munich, Germany) and It emphasised the real need to repeat educational activities, such
allow calcium to enter cells and IRIBHM (Brussels, Belgium). as the ESE course, in order to improve management of endocrine
modulate their polarisation You can learn more about next patients in this European country.
and behaviour. They are year’s event at www.hormones- The event was organised by the Ukrainian Association of
involved in multiple aspects cell-regulation.eu. Endocrinologists, and supported by an unrestricted educational
of the physiological control of grant from Novo Nordisk. The next course is in Visegrád, Hungary,
metabolism, nervous function, Jacques Dumont, President, on 22–25 February 2018 (see www.esepostgraduate2018.hu).
the heart, reproduction, Hormones and Cell Regulation
inflammation etc. Council Marek Bolanowski, Chair, Programme Organising Committee
EndoBridge celebrates 5th year 2nd Polish–Romanian
Endocrine Symposium
Antalya, Turkey, 19–22 October 2017
Wrocław, Poland, 28–29 September 2017
This bilateral meeting dedicated Societies dates back many years,
to the latest advances in clinical with delegates from the societies
endocrinology and endocrine being invited to one another’s
education focused on the meetings. This culminated in the
local characteristics of the two 1st Romanian–Polish Symposium
countries. It featured interesting in Timisoara, Romania, in 2015.
EndoBridge is co-hosted by the Society of Endocrinology and clinical sessions and important The next symposium will see a
Metabolism of Turkey, ESE and the Endocrine Society. This year’s discussions on endocrine return to Romania in 2019 for a
meeting brought together global leaders in endocrinology and specialty education, board meeting in Bucharest.
473 delegates from 39 countries. It was held in English with examinations, the availability We believe our bilateral co-
simultaneous translation into Russian, Arabic and Turkish. of hormonal therapies and operation has an important
Accredited by the European Accreditation Council for reimbursement. impact in the development of
Continuing Medical Education (EACCME) and covering all aspects Co-operation between the European endocrinology.
of endocrinology, the 3-day programme included 24 state-of-the- Polish and Romanian Endocrine
art lectures, 16 interactive case discussion sessions, and poster
case presentations covering over 80 interesting clinical cases.
EndoBridge Founder and President, Bulent Yildiz (Turkey)
commented, ‘In addition to our usual inspiring lectures and
discussion of interesting and challenging clinical cases, the
meeting provided a great opportunity for our colleagues to share
their experiences and perspectives. EndoBridge enhances cross-
cultural dialogue and collaboration in the world of hormones.’
The 6th EndoBridge meeting will be in Antalya, Turkey, on
25–28 October 2018 (see www.endobridge.org).
4
SOCIETY NEWS
EYES at ECE 2018
In light of the forthcoming Congress in Barcelona, EYES was delighted to talk recently to Manuel
Gahete, a young endocrine scientist from Spain. Manuel is organising and chairing the EYES
Symposium at ECE 2018, along with Tatjana Isailovic (Serbia, an EYES Committee member).
Here, he tells us about his interests and enthusiasm for endocrinology.
Manuel, what is your interplay between different Which endocrine organisations
background? endocrine axes (i.e. pituitary, are you involved in?
I am a translational researcher hypothalamus) and metabolic I have tried to be actively involved
in the ‘Hormones and environments (i.e. insulin, in the activities and functioning
Cancer’ Research Group at insulin-like growth factor-I, of the different endocrine
the University of Córdoba somatostatin, ghrelin), and their societies and their affiliated
and Maimonides Biomedical dysregulation during extreme committees, associations
Research Institute of Córdoba. metabolic conditions and cancer. and initiatives led by young
My scientific career has mainly endocrinologists. Indeed, I am
focused on different aspects of What have you been a member of the European
endocrinology and metabolism, working on lately? Neuroendocrine Association
including the identification Nowadays, my research interests (ENEA) Young Researcher
and characterisation of novel are more focused towards Committee (EYRC) and have been
endocrine elements (truncated exploring novel elements involved in many of the activities
somatostatin receptors, splicing and cellular and molecular promoted by EYES. activities promoted by EYES
variants of ghrelin etc.) and their mechanisms (such as alternative through the EYES Meeting,
involvement in pathological splicing, miRNAs and extracellular What do you think about social media and liaison with
situations. This developed vesicles) at the crossroads EYES and EYES activities? other early career endocrine
during my PhD studies under the between the endocrine system, My personal view is that the groups encourage young
supervision of Justo Castaño and the metabolic pathologies EYES Committee has adopted endocrinologists from Europe
Raúl Luque. (obesity, diabetes etc.) and the an admirable and insightful and other countries to pursue
I undertook post-doctoral development and progression approach to promote, and succeed in their scientific
training at the University of of different endocrine-related disseminate and support the careers.
Illinois (Chicago, IL, USA), cancers, such as those of the work carried out by young
supervised by Rhonda Kineman. liver, prostate, pituitary or endocrinologists throughout
Here I investigated the reciprocal neuroendocrine system. Europe and beyond. Indeed, the
A return to Modena:
1st ICGR–GnRH Congress
Just over 2 years ago, the 3rd ‘The control of ovarian cycle from addition of luteinising hormone
EYES Meeting took place in “Prolan A” to “KNDy neurons”’, (LH) or human chorionic
Modena, Italy. This September, with a warm welcome. It was gonadotrophin or human
Modena was again a wonderful heart-warming to see that menopausal gonadotrophin
host to EYES. Manuela Simoni endocrinology is not only about alone. It was very interesting to
(Italy) and Ilpo Huhtaniemi science but also about good learn that FSH alone resulted in
(UK) organised the joint 4th friends and pleasant memories. a higher oocyte number, while
International Conference on Listening to Professor Lunenfeld’s addition of LH resulted in a
Gonadotropins and Receptors retrospective talk on the control higher pregnancy rate.
and the 12th International of the ovarian cycle was one of In a friendly and exciting
Symposium on Gonadotropin- those moments to be treasured environment, EYES is growing
Releasing Hormone. It was one and remembered. and moving forward.
of those very special meetings EYES was very proud to be
filled with new and exciting represented by Daniele Santi Ljiljana Marina
discoveries, as well as great (Italy), who gave a talk on new EYES Committee
energy and good spirit among aspects of gonadotrophin
participants. combinations in assisted
The opening symposium was reproduction. Daniele presented
organised in honour of the 90th results from his latest meta-
birthday of Bruno Lunenfeld analysis, which investigated the
(Israel). Marcella Motta (Italy) efficacy of different regimens
introduced Professor Lunenfeld’s using follicle-stimulating
Bernard Zondek lecture, entitled hormone (FSH) alone or with the
5
FEATURE ARTICLE
Brexit – too many
unanswered questions?
Eighteen months ago, in June 2016, the UK electorate voted by are certainly fewer requests from EU students to attend our institution.
a narrow margin to leave the EU. Both the ‘Leave’ and ‘Remain’ Many students move to other EU countries for study or for work
experience.’
campaigns were criticised then, and the UK Government has been
Medical Research Council (MRC) Senior Clinician Scientist and
criticised since, for an absence of any detail about what ‘Brexit’
Consultant Michele Vacca (Cambridge, UK) comments, ‘Uncertainties
means in practice. are clearly the main reason for this decline in applications, and they
count more than a really bad deal would do. Compared with other EU
In September 2017, in response to calls from the scientific community, countries, UK Research Councils and Government strongly support
the UK Government published a position paper entitled ‘Collaboration research, but we are also heavily sponsored by the EU. Understanding
on science and innovation: a future partnership paper’.1 While if the UK will still be part of the Horizon programme and, if not, what
welcomed as a ‘first step’ in identifying issues to be addressed contingency plans the UK Government will put in place are crucial.’
during the Brexit process, there remains a lack of clarity which Punith Kempegowda is a Specialist Registrar in Birmingham, UK. He
leaves scientists across Europe and the globe uncertain about future says the uncertainty about future collaborations with EU partners has
relations between the UK and its neighbours in the rest of the EU. put him off embarking on research projects at present. Brexit puts the
Endocrinologists are, inevitably, affected by the lack of certainty. UK at risk of ‘a significant impact on research funding,’ Punith reflects,
We canvassed the opinions of several colleagues. These range from ‘The main hit would be for those aspiring to conduct research in the
well-established endocrinologists who moved to the UK some time UK through Marie Curie grants which are provided by the EU.’
ago and now call Britain their home, to others earlier in their careers, Amsterdam-based endocrinologist Maarten Soeters provides a
wondering about the wisdom of moving to the UK, or what the future perspective from outside the UK, though he previously spent 3 years
will hold for those already resident. as a post-doc at the Vidal-Puig lab in Cambridge, supported by a
Marie Curie grant. ‘As a clinical scientist outside the UK, it may be
Residency, recruitment and retention difficult to predict the consequences for my own work. Collaborations
Perhaps the most fundamental concern surrounds the UK’s unclear within Europe are important ... I have been surprised by the quality
future migration policy. Professor Antonio Vidal-Puig (Cambridge, of care and research funded by bodies such as the Wellcome Trust
UK) comments that while his institution maintains a good supportive and the MRC, as well as EU grants. The first two will most likely
working relationship with the EU, ‘...there has been a change in the stimulate collaboration between the UK and other European
mood. Most European researchers who came to my team were also countries after Brexit.’
attracted by the prospect of establishing their career in the UK under
the perception of quality, excellence, internationalisation and easy A looming lack of skills?
integration. This perception is not as optimistic now. There is a new Reflecting on the future of healthcare in the UK, Toni Vidal-Puig
feeling, the one that separates us and them. This feeling is negative is concerned: ‘The combination of leaving the EU, the decrease in
and decreases morale, making engagement and commitment more the value of the pound, and a perception of being more foreign
difficult.’ Professor Luigi Gnudi (King’s College London, UK) adds ‘There incentivises [individuals] moving. The instinct to move is not driven
6
FEATURE ARTICLE
by the lack of jobs. There is a shortage of health-related professionals I have heard say that there is an enormous risk that Europeans will
in the UK and the ageing demographics of the medics will make the go back home, without realising that for many of us, the UK has
problem more difficult. The deficit of nurses and midwives is huge and become our home. The risk [to the UK] is losing, unnecessarily, the
will get worse. This, together with lack of investment in the NHS, may engagement and commitment of the Europeans, and this is something
have devastating effects for the provision of healthcare.’ Government, politicians and people do not seem to realise.’
As regards the future of UK research, Maarten Soeters also fears
a ‘brain drain’, but rests his hopes on the lengthy negotiations: Connections and co-operation
‘Probably, the Brexit effects will become clear during the negotiating Avoiding the isolation of UK medical science is of paramount
process during the upcoming years. Applications for EU funding importance. Luigi Gnudi comments ‘If science were to become
might change, foreign investors in drug or tech companies may be isolated, I see major disruption. Channels will have to remain
challenged, and [there may be] an increased brain drain. It remains to wide open for research and education in general, ALWAYS.’ Punith
be established if the Brexit deal will be as profitable as is expected by Kempegowda agrees: ‘The Government should establish clear
its advocates. On the other hand, the UK may not be that dependent agreements for bilateral co-operation for research between the UK
on the EU and collaborations with other partners such as the USA and and the EU, similar to trade and commerce.’ Michele Vacca adds,
Asia may be luring.’ ‘Make sure that we stay in the Horizon 2020/Marie Curie programmes
Luigi Gnudi also looks to the negotiations, but is not expecting and other things will follow; as members, third parties or with a “new
clarity anytime soon. He says, ‘It will all depend on the agreements deal” – it does not matter – but not being part of the EU scientific
between the EU and UK; now seeing how negotiations are proceeding, community is to commit scientific suicide.’
I am unsure of any outcome. A “so-called” mild Brexit (if it had to There is general agreement with Luigi Gnudi’s closing comment,
happen) would be much preferable. Isolation from the EU would not be ‘I really hope that good sense and pragmatism will prevail over a
welcome and many might decide to move away from the UK.’ complete political nonsense.’ Maarten Soeters remains optimistic
‘The people who voted against Brexit realise that the UK is not the
Make the message clear more or less isolated island it once was. The UK is not immune to the
All the scientists we spoke to feel that the UK Government must take challenges the other EU countries face. The optimist in me expects
urgent steps to offer security and support. Maarten Soeters calls that UK scientists will thrive, although we do not yet know if this
for them to provide some answers, ‘How important is science to the comes with a temporary cost.’
UK Government? And with that clinical care? Innovative strategies?
Supporting science
Long term safety for people and environment? This, for me, is the
fundamental question: is the UK Government (or its voters) interested
in investing or compensating after possible losses inflicted by Brexit?’
Michele Vacca emphasises the need for the UK Government to see ESE is keen to understand its members’ views and concerns about
the situation from the perspective of scientists who have moved to the the impact of Brexit on the European and international endocrine
UK in recent years. ‘The cut-off date to be recognised as “permanent community. Please contact us at info@euro-endo.org if you wish
residents” is still unclear. For those who arrived in the UK in the last 5 to share your thoughts or experience of its impact on scientists,
years there are only uncertainties. Would you buy a house or set up a clinicians, research or healthcare. In future issues of ESE News, we
family, or think to have a child in a country that might ask you to leave if will return to this topic, to share the viewpoints and actions of
you lose your job for a few months? Would you consider embarking on a other groups and organisations.
training programme in the UK if your title is valid only in that country?’
Toni Vidal-Puig offers some heartfelt advice, ‘Change the message.
The most supportive messages indicate that the UK wants Europeans REFERENCES
to stay because we are needed. It would be more effective to say the 1. HM Government 2017 Collaboration on Science and Innovation: a Future
UK wants Europeans to stay because we contribute so much that they Partnership Paper www.gov.uk/government/publications/collaboration-
consider us as one of them. Some of the most supportive messages on-science-and-innovation-a-future-partnership-paper.
7
FEATURE ARTICLE 11 award and
plenary lectures
These lecturers will highlight the most
2018
20th European Congress
of Endocrinology
exciting advances in endocrinology
and metabolism, ranging from the
opening plenary lecture by former ESE
ECE 2018:
President Philippe Bouchard (France) on
the past and future of contraception, to 30 symposia
the closing plenary lecture by Manuel on hot topics
Serrano (Spain) on the metabolic
Renowned experts will cover all focus
control of longevity.
a feast of endocrinology
areas in symposia spanning our field.
Invited speakers will bring together
the very best perspectives on clinical,
Barcelona, Spain, 19–22 May 2018 translational and basic research, as
well as offering a stunning education
16 Meet the Expert
programme just right for potential
The 20th European Congress of Endocrinology promises to sessions for clinicians newcomers to the field and for
be exciting and rewarding. Clinicians, basic and clinical
These will cover important endocrine long-standing professionals.
scientists and leading guest speakers will discuss and
topics such as the use of diabetes
present the latest advances in endocrine research,
technologies to optimise patient
sharing their frontline knowledge and experience with self-care, thyroid cancer, adrenal
international attendees. incidentalomas, erectile dysfunction,
ECE 2018 has been specifically designed to support scientific the management of acromegaly
and professional interaction across all fields of endocrinology after surgery, osteoporosis in men,
and metabolism, from bench to bedside, with the aim of hyperlipidaemia, delayed puberty and 3 Meet the Expert
advancing knowledge and improving patient care. premature ovarian failure. sessions for basic/
The Programme Organising Committee has created an translational scientists
exciting scientific programme featuring the best international,
European and local experts as speakers in a versatile schedule Here you can learn about mouse
covering ESE’s eight focus areas: models in endocrine tumours, single-
cell sequencing in endocrine diseases
• adrenal and neuroendocrine tumours 3 attended and non-classical mechanisms of
• calcium and bone
• diabetes, obesity and metabolism poster sessions thyroid hormone action.
• environment, society and governance We return to the well-established poster
• interdisciplinary endocrinology boards (each poster up for 1 day), to
• pituitary and neuroendocrinology give you the opportunity to personally
• reproductive endocrinology discuss your findings with experts and
• thyroid. students working in various fields. The
guided poster tours will be highlights
at lunchtime, while the electronic
boards and online posters will facilitate
discussions during (and even
after) the Congress.
Sessions 6 exciting debates
for nurses You can see expert speakers ‘battle’
Specialised endocrinology about endocrine disruptors, the use
nurses are catered for by of receptor profiling for predicting
our dedicated Endocrine pituitary therapy, aldosteronism
Nurse and Meet the and hypothyroidism, anti-müllerian
Nurse Expert sessions. hormone as a primary marker of fertility
and screening of thyroid hormones and
6 New Scientific antibodies in pregnant women.
Approaches sessions
Well known experts will cover fresh
ideas and approaches in clinical or
translational endocrine research, such
as the spliceosome and miRNAs as
new tools in endocrine tumours, and Late-breaking
re-programming strategies to obtain news and EYES
functional endocrine units.
A special symposium will discuss
the newest, most exciting topics
in endocrinology, while a session
organised by the European Young
Endocrine Scientists (EYES) will focus on
8 the study of neuroendocrine diseases.
FEATURE ARTICLE
ECE 2018 therefore promises to be an exciting Congress, greatly We very much look forward to welcoming you to the
stimulating discussion and knowledge-sharing. We will also hear about 20th European Congress of Endocrinology on 19–22 May 2018.
ESE’s new guidelines and an update on the European Reference Network So, save the date – and see you in Barcelona!
for rare endocrine conditions (Endo-ERN).
If you share our fascination for the rapidly advancing fields Márta Korbonits, ECE 2018 Programme Committee Chair
of endocrinology,then this is a meeting you simply cannot miss. Barbara Obermayer-Pietsch, ECE 2018 Clinical Co-Chair
You will find no better opportunity to learn about the latest Raúl M Luque, ECE 2018 Basic Science Co-Chair
advances, to interact with world-renowned endocrinologists and
clinical and basic researchers, and to participate in discussions
about some of the most important issues facing us in daily
clinical practice. You will have the chance to renew old friendships
Key dates
and make new ones and to take part in outstanding networking Remember to submit your abstracts by 29 January.
opportunities while enjoying the Mediterranean atmosphere. The early bird registration deadline is 6 April 2018.
Our award lecturers in the pathophysiology and treatment of energy deficiency states
(lipodystrophy, hypothalamic amenorrhoea etc.). Subsequent work
resulted in the paradigm-shifting concept that adipose tissue is not
Christos Mantzoros an inert energy storage organ but an active endocrine organ – this
Geoffrey Harris Award revolutionised the way endocrinologists view metabolic disorders.
In the mid-1990s, leptin’s discovery raised Neuroendocrine abnormalities and metabolic diseases, including
hopes of a treatment for obesity. Named obesity and its comorbidities, diabetes, cardiovascular disease
from the Greek ‘leptos’ (meaning thin), and malignancies, are the epidemics of the 21st century. My
leptin secreted by fat cells appeared to laboratory’s many novel discoveries associated with these disorders
switch off the urge to eat in preclinical have contributed to our understanding of underlying mechanisms.
animal studies. I will present my findings along with translational contributions
My laboratory was the first to perform that advanced our understanding of the physiology and therapeutic
pharmacokinetic studies of leptin in humans. We subsequently found utility of leptin and adipokines in humans, the development of novel
that, although leptin at supraphysiological levels may decrease diagnostic and therapeutic tools for neuroendocrine and metabolic
body weight in lean subjects, this did not translate to overweight disease, and our knowledge of other key molecules and hormones
or obese humans. We were also first to demonstrate leptin’s role in secreted by muscle and the gastrointestinal tract.
the human neuroendocrine response to energy deprivation, and
.
Filip Knop suggesting that the gut may play a hitherto underestimated role
European Journal of in type 2 diabetic hyperglucagonaemia. To better understand this, we
Endocrinology Award have performed studies which suggest that the gut-derived hormone
Glucagon’s role as a glucose-mobilising glucose-dependent insulinotropic polypeptide may be involved.
hormone secreted from pancreatic α-cells In addition, we recently undertook studies in totally
during low blood glucose concentrations pancreatectomised patients using mass spectrometry which
represents a well-established and proved that glucagon (hitherto considered a pancreas-specific
fundamental part of human physiology. hormone) may also be secreted from extrapancreatic tissues. This
Likewise, hyperglucagonaemia is most likely to be from proglucagon-producing enteroendocrine
constitutes an acknowledged part of diabetes pathophysiology, cells immunohistochemically positive for the enzyme prohormone
contributing by as much as 50% to the aberrant hyperglycaemia in convertase 2 (previously considered to be limited to pancreatic
type 2 diabetes. α-cells). We also identified such cells in patients with type 2 diabetes,
Nevertheless, the cause of and mechanisms underlying explaining their postprandial hyperglucagonaemia.
hyperglucagonaemia in type 2 diabetes are incompletely understood. The observation that gut-derived glucagon is likely to play an
The general understanding is that the diabetic α-cells are less important role in diabetic pathophysiology has improved our
sensitive to the glucagon-suppressive effects of glucose and insulin. understanding of the disease and may lead to new treatment
However, this notion has recently been challenged by studies strategies.
Philippe Chanson excess mortality and that cardiovascular disease is not the leading
Clinical Endocrinology cause of death. This is thanks to effective treatment of acromegaly and
Trust Award aggressive management of comorbidities (diabetes, hypertension, lipid
Growth hormone (GH) and insulin-like disorders). Observations resemble those in the background general
growth factor-I (IGF-I) have important population.
metabolic actions. GH/IGF-I excess and In contrast, the clinical features of hypopituitarism with GH deficiency
GH deficiency are each associated are more like those of the metabolic syndrome. This may explain why
with ‘opposing’ comorbidities that patients have an increased cardiovascular and cerebrovascular risk. GH
often mirror one another. Cardiac treatment improves cardiovascular risk factors and is associated with a
and vascular comorbidity demonstrates decreased incidence of cardiovascular (but not cerebrovascular) events
that ‘too much’ may be as bad as ‘too little’. in some studies. It also seems to be associated with a reduction in all-
An association between acromegaly and increased cardiac mortality cause mortality in both sexes, but particularly in males, who attain the
has long been claimed. This was based on epidemiological studies level of the general population.
of patients treated a long time ago, when the current therapeutic Thus, according to our homeostatic model, the GH/IGF-I axis follows
tools were not available and radiotherapy was widely used. Recent the general rule that in medio stat virtus or ‘virtue stands in the middle’!
epidemiological studies and data from acromegaly registries show no
9
THE ENDO EXPLORER
The Endo Explorer
Evolving a passion
for endocrinology
After two decades of evolution
Like everything else in life, research groups develop and evolve.
At the turn of this century, the team of Paco Gracia-Navarro grew,
under the joint leadership of his former disciples Maria Malagón
and Justo Castaño, to unveil the cellular and molecular signalling
mechanisms underlying the regulatory actions of ghrelin, PACAP
(pituitary adenylate cyclase-activating polypeptide), growth hormone-
releasing hormone, somatostatin, adipokines and their receptors
in somatotrophs and other pituitary cell types. In addition, they
explored the role of novel players in the processing and trafficking
of pituitary hormones, particularly in melanotrophs. These multiple
interests naturally led to the generation of two novel, independent
research groups, led by Professors Malagón and Castaño, which
Justo Castaño and Raúl Luque’s group expanded their particular endocrine interests into two strongly
emerging fields: adipobiology and endocrine oncology respectively.
In retrospect, one realises that endocrinology was deeply At about the same time, Dr Aguilar’s group passed the baton
engraved on the heart, and the fate, of Córdoba, the on to a new leader, his disciple Manuel Tena-Sempere, who
was busy at the time igniting the ‘Kiss’ explosion in the field
beautiful Spanish city of famous physicians like Avicena
of reproductive neuroendocrinology. Indeed, Tena-Sempere’s
and Maimonides. team robustly contributed to the discovery and dissection of
the kisspeptin system as a key player in the control of puberty
In the beginning... in particular and, more broadly, in reproductive physiology.
Indeed, almost 40 years ago, in the midst of the golden era of
neuroendocrinology, while competing labs were boiling the To the present day
world over to discover, isolate and characterise the ‘predicted’ Currently, Manuel Tena-Sempere’s highly productive group focuses
hypophysiotrophic hypothalamic hormones (then named ‘factors’), their activities on reproductive and metabolic neuroendocrinology,
a very young university was giving birth to two initially unrelated with particular interest in the neuroendocrine regulation of
research labs, which were to become a true endocrine-related energy homeostasis, puberty and the reproductive axis, and
scientific family – although, at that time, we just did not know it. the reciprocal interplay between these key bodily functions.
In 1978, at the Department of Cell Biology of the School of Biological The ultimate aim of this team is to understand the basis for
Sciences, Francisco (Paco) Gracia-Navarro was completing his seminal alterations of puberty and fertility linked to severe metabolic
PhD dissertation on the ultrastructural and functional characterisation disturbances, from obesity to anorexia, and to decipher the
of amphibian pituitary cell types, introducing ‘modern’ techniques such mechanisms of metabolic perturbations associated with gonadal
as immunofluorescence and immunoelectron microscopy, and creating dysfunction. This is a basic science research group, which
a group of comparative endocrinologists, who became very active routinely uses suitable preclinical models, including genetically
players within the European Society for Comparative Endocrinology modified lines, and implements a wide arsenal of analytical
(ESCE), and organised their 17th Congress in Córdoba in 1994. techniques. However, the group has also developed a strong drive
Soon thereafter, Paco Gracia-Navarro became the first for translational research, which materialises in various projects
President of the newly created Iberian Association of Comparative addressing prevalent human diseases, including polycystic
Endocrinology (AIEC). In the 1980s and 1990s, results from this ovary syndrome and other reproductive pathologies, pubertal
group contributed to the understanding of the mechanisms alterations, obesity and related metabolic perturbations.
underlying the hypothalamic regulation of pituitary function in
frogs, pigs and rats, paying special attention to somatotrophs
and melanotrophs, and to the then emerging concepts of
heterogeneity of endocrine cell types and the secretory cell cycle.
A few blocks away, Enrique Aguilar Benítez de Lugo, a physician
scientist who arrived at the Physiology Section of the School of Medicine
in 1980, initiated the building of a new research group focused on
reproductive physiology, with special emphasis on the neuroendocrine
mechanisms regulating puberty, fertility and reproductive health and their
interactions with growth and metabolism. The group applied classic and
novel methodologies in experimental neuroendocrinology to characterise,
using rodent models, the role of gonadal hormones and different
neurotransmitters in the central control of sex differentiation and
pituitary secretion, with special attention to gonadotrophins, prolactin
and growth hormone, thereby fostering quality research in this field. Maria Malagón’s group
10THE ENDO EXPLORER
‘The best part of the journey has
been the number of incredible
collaborators and friends that we
have met and enjoyed along the
way: we thank them all’
Manuel Tena-Sempere’s group
With help from our friends
Our teams have always actively collaborated, and our development
would not have been the same without close interaction with
clinical research teams in Córdoba, at the Reina Sofia University
Hospital and the Maimonides Institute of Biomedical Research
of Córdoba (IMIBIC). The best part of the journey has been
the number of incredible collaborators and friends that we
have met and enjoyed along the way: we thank them all.
We have always believed very strongly in the value of scientific
societies, and remain actively involved in the life of ESE and its major
Enrique Aguilar Benítez de Lugo Francisco Gracia-Navarro
Congress (remembering that ECE 2018 is coming to Barcelona), as
Over the last decade, Dr Malagon’s group has focused on elucidating well as many other related national and international societies.
the cellular and molecular mechanisms underlying adipose tissue Writing this perspective has prompted us to believe that the strong
(dys)function, in order to unveil the pathogenic pathways leading to endocrine-related family which has grown and evolved around our
the development of metabolic disease in obesity. Taking advantage university and hospital, and lives now at IMIBIC, will continue to flourish.
of their previous background in cell signalling and intracellular Our labs and research are open to welcome your collaboration!
membrane traffic in endocrine cells, the group, co-led by Rafael
Vázquez-Martínez, has significantly contributed to identifying novel Justo Castaño, María Malagón, Manuel Tena-Sempere
players in insulin signalling and lipid traffic, such as septins, and to and Raúl Luque
further understanding the function and regulation of the central Maimonides Institute for Biomedical Research of Córdoba (IMIBIC);
regulatory hub for lipid storage and mobilisation in adipocytes, Department of Cell Biology, Physiology and Immunology, University
the lipid droplet, under the orchestration of Rab proteins. of Córdoba; Reina Sofia University Hospital; and CIBER Fisiopatología
The group has also pioneered the application of different proteomic de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
techniques in the study of human adipose tissue, including the analysis
of protein post-translational modifications. They have recently This article is dedicated to the memory of our colleagues
developed a unique protocol for MALDI (matrix-assisted laser desorption Enrique Aguilar Benítez de Lugo and Rafael Vázquez-Martínez,
ionisation) imaging, to analyse the distribution of lipids in human two excellent endocrine researchers and fine men, whose
adipose tissue sections, which are being used to establish the protein untimely death this year has left us heartbroken.
and lipid fingerprints of the adipose tissue in health and disease.
Meanwhile, the hormones and cancer research group, co-
directed by Raúl Luque and Justo Castaño, has centred its efforts
on understanding the cellular and molecular principles underlying
the natural processes of neuroendocrine regulation of pituitary
cell types. They have paid special attention to somatotrophs and Renew your
membership for 2018
the somatostatin and ghrelin systems, their relationship with
metabolism, and their dysfunction in tumour diseases and cancer.
In this context, the discovery of novel splicing variants of these two
neuropeptide systems (sst5TMD4 and In1-ghrelin) opened up new
research avenues to establish their presence and pathophysiological Stay part of the European endocrine
relevance in different endocrine-related cancers. This ultimately led
to the exploration of the role of alternative splicing and its defects in
community and maintain your
hormone-related tumours and cancer. So, departing from a comparative access to some great benefits!
endocrinology setting, this team has also embraced translational
research, in the quest for the discovery and application of relevant Sign into your account on the
changes that could have diagnostic or prognostic value and could ESE website to renew today.
contribute to the future design of innovative therapeutic strategies.
Moreover, while keeping a close eye on hormones and so www.ese-hormones.org
remaining endocrinologists, our teams have embarked down
some of endocrinology’s broad research ‘tentacles’ by analysing,
for instance, the metabolic control of hormonal secretion and
endocrine cancers or exploring the hormonal regulation of adipocytes
and cancer cells. Likewise, an integrative scientific approach has
characterised our vision of endocrinology, where whole animal
studies at a physiological level have been combined with intimate
molecular approaches, to understand the role of specific signals
and receptors, using genomics, proteomics or spliceosomics.
11EDITOR’S SELECTION
EJE
ISSN 0804-4643 (print)
European Journal of Endocrinology
ISSN 1479-683X (online) Sharing knowledge enabling collaboration
Volume 178, Number 1
January 2018
eje-online.org
EJE European Journal
ISSN 0804-4643 (print)
Aggressive
ISSN 1479-683X (online)
Volume 178, Number 1
Contents
CLINICAL PRACTICE GUIDELINE
of Endocrinology January 2018
eje-online.org
G1–G24 European Society of Endocrinology Clinical Practice 33–41 Marked geographic patterns in the incidence of idiopathic central
Volume 178 Number 1
Guidelines for the management of aggressive pituitary precocious puberty: a nationwide study in France
tumours and carcinomas Joëlle Le Moal, Annabel Rigou, Alain Le Tertre,
Gerald Raverot, Pia Burman, Ann McCormack, Anthony Heaney, Perrine De Crouy-Channel, Juliane Léger and Jean-Claude Carel
Stephan Petersenn, Vera Popovic, Jacqueline Trouillas and
43–56 Modulation of the gut microbiome: a systematic review of the
Olaf M Dekkers on behalf of The European Society of Endocrinology
effect of bariatric surgery
Yan Guo, Zhi-Ping Huang, Chao-Qian Liu, Lin Qi, Yuan Sheng and
Da-Jin Zou
DEBATE
59–65 Somatic USP8 mutations are frequent events in corticotroph
Impact
D1–D12 Identifying and treating subclinical thyroid dysfunction in
pregnancy: emerging controversies tumor progression causing Nelson’s tumor
Inés Velasco and Peter Taylor Luis G Pérez-Rivas, Marily Theodoropoulou, Troy H Puar, Julia Fazel,
Mareike R Stieg, Francesco Ferraù, Guillaume Assié, Monica R Gadelha,
January 2018
Timo Deutschbein, Maria C Fragoso, Benno Kusters, Wolfgang Saeger,
REVIEWS Jürgen Honegger, Michael Buchfelder, Márta Korbonits, Jérôme Bertherat,
Günter K Stalla, Ad R Hermus, Felix Beuschlein and Martin Reincke
R1–R9 DIAGNOSIS OF ENDOCRINE DISEASE: 18-Oxocortisol and
factor:
18-hydroxycortisol: is there clinical utility of these steroids? 67–76 Targeting either GH or IGF-I during somatostatin analogue
treatment in patients with acromegaly: a randomized
Jacques W M Lenders, Tracy Ann Williams, Martin Reincke and
multicentre study
Celso E Gomez-Sanchez
pituitary tumours:
Jakob Dal, Marianne Klose, Ansgar Heck, Marianne Andersen,
Pages E1–E2, G1–G70, R99–R158, 243–276
R11–R17 DIAGNOSIS of ENDOCRINE DISEASE: SDHx mutations: beyond Caroline Kistorp, Eigil H Nielsen, Jens Bollerslev,
pheochromocytomas and paragangliomas Ulla Feldt-Rasmussen and Jens O L Jørgensen
Massimo Mannelli, Letizia Canu, Tonino Ercolino, Elena Rapizzi,
4.101
77–84 Early post-treatment risk stratification of differentiated thyroid
Serena Martinelli, Gabriele Parenti, Giuseppina De Filpo and
cancer: comparison of three high-sensitive Tg assays
Gabriella Nesi
Luca Giovanella, Mauro Imperiali, Frederik A Verburg and
R19–R31 DIAGNOSIS OF ENDOCRINE DISEASE: Bone turnover markers: Pierpaolo Trimboli
are they clinically useful?
85–93 ETV6-NTRK3 and STRN-ALK kinase fusions are recurrent events in
Richard Eastell, Tom Pigott, Fatma Gossiel, Kim E Naylor,
papillary thyroid cancer of adult population
Jennifer S Walsh and Nicola F APeel
André Uchimura Bastos, Ana Carolina de Jesus and
Janete Maria Cerutti
CLINICAL STUDIES 95–104 Excess morbidity and mortality in patients with
1–9 The impact of vitamin D status on hungry bone syndrome craniopharyngioma: a hospital-based retrospective cohort study
after surgery for primary hyperparathyroidism Mark Wijnen, Daniel S Olsson, Marry M van den Heuvel-Eibrink,
Reto Martin Kaderli, Philipp Riss, Daniela Dunkler, Peter Pietschmann, Casper Hammarstrand, Joseph A M J L Janssen, Aart J van der Lely,
Andreas Selberherr, Christian Scheuba and Bruno Niederle Gudmundur Johannsson and Sebastian J C M M Neggers
11–22 The metabolic syndrome and its components in 178 patients 105–113 Time to parathyroid function recovery in patients with
treated for craniopharyngioma after 16 years of follow-up protracted hypoparathyroidism after total thyroidectomy
Mark Wijnen, Daniel S Olsson, Marry M van den Heuvel-Eibrink, Inés Villarroya-Marquina, Juan Sancho, Leyre Lorente-Poch,
Casper Hammarstrand, Joseph A M J L Janssen, Lander Gallego-Otaegui and Antonio Sitges-Serra
Aart-Jan van der Lely, Gudmundur Johannsson and
115–122 Incidence, prevalence and seasonal onset variation of Addison’s
Sebastian J C M M Neggers
disease among persons with type 1 diabetes mellitus: nationwide,
matched cohort studies
a new ESE guideline
23–32 Characteristics of a nationwide cohort of patients presenting
with isolated hypogonadotropic Dimitrios Chantzichristos, Anders Persson, Björn Eliasson, Mervete Miftaraj,
hypogonadism (IHH) Stefan Franzén, Ann-Marie Svensson and Gudmundur Johannsson
Marco Bonomi, Valeria Vezzoli, Csilla Krausz, Fabiana Guizzardi,
123–130 Individual testosterone decline and future mortality risk in men
Silvia Vezzani, Manuela Simoni, Ivan Bassi, Paolo Duminuco,
Clinical &
Natascia Di Iorgi, Claudia Giavoli, Alessandro Pizzocaro, Gianni Russo, Stine A Holmboe, Niels E Skakkebæk, Anders Juul, Thomas Scheike,
Mirella Moro, Letizia Fatti, Alberto Ferlin, Laura Mazzanti, Tina K Jensen, Allan Linneberg, Betina H Thuesen and Anna-
Maria Chiara Zatelli, Salvo Cannavò, Andrea M Isidori, Maria Andersson
translational
Angela Ida Pincelli, Flavia Prodam, Antonio Mancini, Paolo Limone, 131–137 Metformin in gestational diabetes mellitus: predictors of poor
Maria Laura Tanda, Rossella Gaudino, Mariacarolina Salerno, response
Pregnolato Francesca, Mohamad Maghnie, Mario Maggi, Luca Persani
Inês Gante, Luís Melo, Jorge Dores, Luísa Ruas and Maria do Céu
endocrinology
on behalf of the Italian Network on Central Hypogonadism (NICe group)
Almeida
from around
bioscientifica.com the globe
0804-4643(201801)178:1;1-U
ESE’s latest clinical practice guideline addresses pituitary information from 166 patients (24% pituitary carcinomas and 76%
tumours that are resistant to conventional treatment. While aggressive pituitary tumours), including 157 patients treated with
temozolomide as first-line therapy after failure of conventional
such cases are rare, the need for guidance was indisputable, therapies.1
as Gérald Raverot explains.
Establishing guidance
Pituitary tumours are usually benign, revealed by symptoms In parallel to this survey, and initiated by current ESE Clinical
associated with hormonal dysregulation (hypersecretion or deficit) or Committee Chair Jérôme Bertherat, we began to develop a guideline
signs associated with tumour growth (such as visual field defects or on diagnosis, treatment and follow up in aggressive pituitary tumours
headaches). Most of these tumours are well controlled by surgery and/ and carcinomas. The rarity of the condition, the absence of controlled
or medical treatment and, in some cases, radiation therapy. However, trials and the limited data from the literature underlined the need to
a subset of tumours proves resistant to the conventional approach. provide clinical guidance.
These patients present with multiple recurrence (so-called aggressive With the help of Olaf Dekkers, our methodological expert, we
pituitary tumours) and, in rare cases, metastasis (a defining feature of decided up front, while acknowledging that literature on aggressive
pituitary carcinomas). pituitary tumours and carcinomas is scarce, to systematically review
Different inefficient therapeutic options were tested before the literature according to the GRADE (Grading of Recommendations
the successful introduction of temozolomide for the treatment of Assessment, Development and Evaluation) system.
aggressive pituitary tumours and pituitary carcinomas. Temozolomide The review focused primarily on first- and second-line treatment
is an alkylating agent indicated in the treatment of glioblastoma. in aggressive pituitary tumours and carcinomas. We included 14
It was used for the first time in 2006 for the treatment of pituitary single arm cohort studies (including at least three patients), most on
carcinoma. Following the first publication, numerous case reports and temozolomide treatment (n=11). This review demonstrated a positive
small series were published demonstrating the potential efficacy of effect in 47% (95% CI 36–58%) of temozolomide-treated cases,
this new treatment. However, many questions regarding treatment confirming temozolomide as the first-line treatment after failure of
efficacy and patient management in this rare condition remained. conventional therapy in aggressive pituitary tumours and carcinomas.
Experience was gleaned from limited patient numbers with short The working group had four face-to-face meetings to draft the
duration of follow up. guideline. A critical review by eight pituitary experts (including
two neurosurgeons and one neuroradiologist) and comments from
A need to answer questions ESE members and the ESE Council of Affiliated Societies (ECAS)
To address these questions, Pia Burman (then Chair of the ESE Clinical contributed to the final form of the recommendations. Moreover, the
Committee) initiated the formation of a Special Interest Group on Endocrine Society endorsed this ESE Clinical Practice Guideline for
aggressive pituitary tumours. The group met for the first time during the Management of Aggressive Pituitary Tumours and Carcinomas,
ECE 2015 in Dublin, Ireland. confirming its worldwide interest. The guideline has recently been
The group’s first initiative was an international survey to collect published in European Journal of Endocrinology.2
information on larger patient cohorts and specifically to gather
experience on temozolomide treatment, other chemotherapeutic Key recommendations
drugs and peptide receptor radionuclide therapy. This survey The following recommendations are central to the new ESE guideline:
was distributed to ESE members. We were able to collect clinical
(1) P atients with aggressive pituitary tumours should be managed by
a multidisciplinary expert team.
(2) Histopathological analysis, including pituitary hormones and
proliferative markers, is needed for correct tumour classification.
(3) Temozolomide monotherapy is the first-line chemotherapy for
aggressive pituitary tumours and pituitary carcinomas after failure
of standard therapies. Treatment evaluation after three cycles
allows identification of responder and non-responder patients.
(4) In patients responding to first-line temozolomide, we suggest
continuing the treatment for at least 6 months in total.
Furthermore, the guideline offers recommendations for patients who
recurred after temozolomide treatment, for those who did not respond
to temozolomide, and for patients with systemic metastasis.
The guideline panel: (L–R) Jacqueline Trouillas, Stephan Petersenn, Anthony Heaney,
Pia Burman, Ann McCormack, Vera Popovic, Gérald Raverot (Olaf Dekkers was absent)
12You can also read
