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Adrenal and Pituitary
Bone/Calcium
Diabetes
Obesity and Lipids
Reproductive Endocrinology
Thyroid


Adrenal and Pituitary

Lectures

Prolactinomas are Sometimes Harder to Treat

Highlights

  • Is treatment with dopamine agonists increasing impulsivity in patients with hyperprolactinemia?

Learning Objectives

  • Assess the long-term risks of dopamine agonists for prolactinomas and when to withdraw therapy
  • Recognize impulsivity in patients treated with dopamine agonists
  • Discuss management of prolactinomas before and during pregnancy
  • Understand how to treat a large prolactinoma refractory to dopamine agonists

What's New in Primary Aldosteronism?

Highlights

  • When to test for primary aldosteronism
  • When to ignore the clinical practice guidelines
  • Making sense of conflicting reports in the literature on the role for adrenal vein sampling

Learning Objectives

  • Review the updated guidelines in diagnosis and treatment of primary hyperaldosteronism
  • Explain the high incidence of primary hyperaldosteronism
  • Assess the utility of confirmatory testing and when we need it
  • Discuss the role of adrenal venous sampling vs. CT imaging

Adrenal Fatigue is Not Adrenal Insufficiency

Highlights

  • “Doctor, I took the on-line quiz and it says I have adrenal fatigue...” What do you do next?

Learning Objectives

  • Explain why adrenal fatigue is not a real diagnosis
  • Discuss optimal testing for adrenal insufficiency in a patient with suspected adrenal fatigue
  • Discuss long term risks of treating with glucocorticoids for patients with normal HPA axis

Neuroendocrine Imaging

Highlights

  • A case-based discussion for clinicians on the imaging techniques used in the diagnosis, staging, and follow-up of neuroendocrine tumors

Learning Objectives

  • Discuss newly approved somatostatin receptor-based imaging technique

Debates

Controversies in the Diagnosis and Management of Acromegaly

Highlights

  • Are we getting closer to an individualized medical therapy regimen?
  • Many new and old medications are available—which one do you use, and when?

Learning Objectives

How to Monitor Therapy—GH, IGF-1, or Both?

  • Apply updated guidelines in diagnosis and monitoring treatment outcomes using biochemical assays for IGF-1 and GH
  • Discuss role of OGTT for GH in patients on medical therapy
  • Review cases with discordant results between GH and IGF-1 after surgery and while on medical therapy and discuss clinical significance of discordant GH-IGF-1 results

Medical Therapy When Surgery Fails

  • Select among medical management options for the treatment of acromegaly taking into consideration efficacy, side effects, and combination strategies
  • Review newer data on role of pathology, T2 MRI appearance in predicting response to therapy

When is Radiation Therapy Indicated?

  • Recognize role of radiation in the treatment armamentarium for acromegaly and discuss role in aggressive GH secreting adenomas
  • Evaluate remission rates of stereotactic radiation vs conventional radiation and discuss risk of hypopituitarism and other complications postradiation

Controversies in the Diagnosis and Management of Cushing Syndrome

Highlights

  • When is salivary cortisol helpful—or not—in the diagnosis of Cushing syndrome?
  • Should we treat with medications or bilateral adrenalectomy a patient with Cushing syndrome that failed or recurs after transphenoidal surgery?

Learning Objectives

The Role of Salivary Cortisol in Diagnosis and Follow-up

  • Discuss the role of salivary cortisol in the diagnosis of Cushing syndrome
  • Review a clinical case with confirmed diagnosis of Cushing disease where salivary cortisol was normal and UFC was high; limitations, false negative and positive results using salivary cortisol testing
  • Assess the role of salivary cortisol in the diagnosis the recurrence of Cushing disease and emphasize the potential delay between abnormal salivary cortisol and abnormal UFC

The Role of Medical Therapy When Surgery Fail

  • Assess available interventions and select appropriate therapy in the treatment and management of patients with Cushing syndrome
  • Explain the role of the hypothalamic-pituitary axis and use of somatostatin receptor ligands and dopamine agonists in Cushing disease
  • Review the role of adrenal steroidogenesis inhibitors in the treatment of Cushing disease
  • Explain the role of glucocorticoid receptor blockade in the management of hyperglycemia associated with Cushing syndrome

When is Bilateral Adrenalectomy Indicated?

  • Review the benefits and risks associated with bilateral adrenalectomy
  • Assess risk of and discuss diagnosis and management of corticotroph tumor progression (Nelson syndrome)
  • Review data on bilateral adrenalectomy-associated mortality
  • Discuss bilateral adrenalectomy in a patient desiring pregnancy

Meet-the-Professor (MTP) Sessions

Growth Hormone Treatment in Adults: Diagnosis and Monitoring

Highlights

  • A case-based discussion regarding unique challenges in diagnosing GH deficiency in adult patients
  • How to select and interpret biochemical tests

Learning Objectives

  • Interpret the results of the GH stimulation test in an obese patient with hypopituitarism according to the available BMI-related cutoff limits defined for that test
  • Select and/or optimize growth hormone therapy in growth hormone deficient adults taking patient needs and clinical outcomes into consideration
  • Evaluate the potential benefits and risks of growth hormone therapy in long-term management of growth hormone deficiency using up to date information

Management of Diabetes Insipidus

Highlights

  • Treating diabetes insipidus in pregnancy can be challenging; how to manage diabetes insipidus when the thirst mechanism is absent

Learning Objectives

  • Describe the triphasic response after pituitary surgery and review management of diabetes insipidus in both inpatient and outpatient setting
  • Discuss a patient with diabetes insipidus in pregnancy
  • Identify adipsic diabetes insipidus and review management in an outpatient setting

Management of SIADH

Highlights

  • Is low sodium a problem, and can we "fix" it?

Learning Objectives

  • Using a clinical case, describe the signs and symptoms associated with early hyponatremia
  • Review the efficacy and safety data of pharmacotherapies for the treatment of patients with SIADH
  • Identify within an illustrative case the role of vasopressin receptor antagonists in the management of patients with SIADH

Glucocorticoid Replacement Therapy

Highlights

  • How to get glucocorticoid replacement right—not too much, but not too little either

Learning Objectives

  • Discuss a case with secondary adrenal insufficiency after surgical treatment of Cushing: how to taper the glucocorticoid replacement in an inpatient and outpatient setting; when and how to test for recovery of HPA axis
  • Discuss a patient with primary adrenal insufficiency who desires pregnancy: management before and during pregnancy
  • Discuss a patient with longstanding adrenal insufficiency who is overreplaced with glucocorticoid: discuss optimal doses of replacement, risks and comorbidities of overreplacement, review recent clinical guidelines

Secondary Hypertension

Highlights

  • A step-by-step evaluation of two challenging cases of endocrine hypertension—and, along the way, share key clinical pearls and dispel common misconceptions

Learning Objectives

  • A case-based review of various forms of secondary hypertension (focusing on causes other than primary hyperaldosteronism and Cushing)

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Bone/Calcium

Lectures

Postmenopausal Osteoporosis: Role/Timing of Anabolic Therapies

Highlights

  • The recent approval of new bone forming (anabolic) agents ushers in a new era for the treatment of osteoporosis. Clinical studies document the fracture protective effects of an anabolic drug followed by an anti-remodeling agent. These regimens, their effects and where they fit into the treatment paradigm will be discussed in this presentation.
  • New anabolic agent(s) just approved!

Learning Objectives

  • Select appropriate patients for anabolic therapy
  • Anabolic and antiresorptives therapy in sequence or combination
  • The role of anabolic therapies for fracture healing

The Risk of Atypical Femur Fractures and Osteonecrosis of the Jaw

Highlights

  • Buff up your skills to talk to patients and other providers about rare problems from osteoporosis treatments

Learning Objectives

  • Review guidelines for management of rare complications
  • Osteoporosis management after AFF or ONJ
  • Role of single energy femur scan on DXA machine
  • How to talk to your patients about rare complications

Managing a Patient Who Fractures on Osteoporosis Treatment

Highlights

  • When is a fracture a failure of treatment?

Learning Objectives

  • Evaluate for potential causes
  • Decide which workup needs to be performed
  • Decide rationally which therapeutic changes, if any, should be made

Hypoparathyroidism: Guidelines and New Treatments

Highlights

  • Is PTH replacement right for every patient?

Learning Objectives

  • Review long term consequences of hypoparathyroidism and its treatment
  • Select patients appropriate for PTH replacement vs standard treatment
  • Managing patients on PTH replacement

Meet-the-Professor (MTP) Sessions

Fractures in Diabetes: Risk Factors, Assessment, and Clinical Recommendations

Highlights

  • Should we add osteoporosis to the list of complications of diabetes?

Learning Objectives

  • Diabetes as a risk for fracture
  • Understand physiology of diabetes that may impact fracture risk
  • Select patients with diabetes for screening and treatment
  • Follow up and treatment duration

Bones and Stones After Bariatric Surgery

Highlights

  • An overview of the metabolic issues related to calcium that will occur when a very heavy individual loses a lot of weight and no longer needs the extra bone mass to carry around the lighter framework

Learning Objectives

  • Bone and calcium physiology after bariatric surgery
  • Perform an assessment of elevated PTH in a bariatric surgery patient
  • Fracture risk after bariatric surgery
  • Choose optimal supplements for bone health after bariatric surgery

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Diabetes

Lectures

Management of Diabetes in Patients with ESRD and CKD: Therapeutic Options and Considerations

Highlights

  • Renal failure is a common comorbidity among patients with diabetes, and treatment options are limited.

Learning Objectives

  • Compare the efficacy and safety of treatment options for patients with moderate and advanced kidney disease
  • Review the evidence for differential renal outcomes among glucose lowering therapies

Practical Approach to Diagnosing and Treating Monogenic Diabetes (MODY)

Highlights

  • With advances in genetic diagnosis and decreasing costs of genetic testing, MODY is increasingly being recognized among patients previously thought to have more common types of diabetes mellitus

Learning Objectives

  • Provide practical considerations for screening appropriate patients with diabetes for MODY
  • Describe longer-term outcomes for MODY subtypes
  • Review best practices for MODY subtypes

Prevention and Management of Severe Hypoglycemia Unawareness: Incorporating Sensor Technology

Highlights

  • Hypoglycemia is the major factor limiting achievement of glycemic control in patients with diabetes. Sensor technologies have been shown to reduce hypoglycemia frequency and increase time in target glucose range.

Learning Objectives

  • Describe the clinical consequences of hypoglycemia and hypoglycemia unawareness among patients with type 1 diabetes
  • Evaluate the evidence supporting sensor technology for hypoglycemia prevention and recognition and improvement of glycemic control
  • Provide guidance of incorporation of the latest sensor technologies into practice

Combining Basal Insulin and Non-Insulin Agents in Type 2 Diabetes Treatment

Highlights

  • Recent clinical trials and combination medications have changed the traditional approach to basal bolus insulin therapy.
  • Traditionally, rapid acting insulin is indicated when patients fail to achieve glycemic control with basal insulin. Recent studies suggest that GLP-1 RA, SGLT-2 inhibitors and DPP-4 inhibitors are viable options to multiple daily insulin regimens. Studies supporting these options will be discussed.

Learning Objectives

  • Review the most recent treatment guidelines for combining basal insulin with non-insulin therapies for glucose control
  • Compare and contrast combination injectable (basal plus) regimens

Early Combination Therapy in Type 2 Diabetes

Highlights

  • Early combination therapies may reduce clinical inertia and improve glucose control better than sequential treatment additions.

Learning Objectives

  • Characterize the patient population for whom early combination therapy is warranted
  • Describe the evidence for synergistic effects among newer diabetes therapies
  • Describe the effect of early combination therapy on prevention of beta-cell decline

Debate

What's Next After Metformin in Patients with Type 2 Diabetes and Cardiovascular Disease?

Highlights

  • There are now two classes of FDA-approved glucose lowering agents that have demonstrated cardiovascular benefits in long-term outcomes trials. How does this change our practice?
  • Cardiovascular disease is the leading cause of death in patients with diabetes. Several cardiovascular outcome studies of the newer antihyperglycemic therapies have been reported, with variable results. Whereas most of the studies have shown cardiovascular safety, recently some of the studies have demonstrated a cardiovascular benefit. There will be an interactive discussion of how to choose anti-hyperglycemic therapies in patients with cardiovascular disease.

Learning Objectives

  • Debate the addition of empagliflozin vs. liraglutide to metformin for patients with type 2 diabetes and known cardiovascular disease
  • Provide an update on the landscape of CV outcomes trials in 2017
  • Describe the role of SGLT-2 inhibitors versus GLP-1 receptor agonists in the latest treatment guidelines

Meet-the-Professor (MTP) Sessions

Diabetes Treatment in the Elderly

Highlights

  • Elderly patients are at increased risk for hypoglycemia and other adverse effects from glucose lowering therapies and are more likely to suffer from comorbidities and polypharmacy.

Learning Objectives

  • Illustrate the burden and consequences of hypoglycemia specific to elderly patients with diabetes mellitus
  • Illustrate overall treatment approach in elderly patients with diabetes mellitus

Progress Toward Closed Loop Insulin Delivery

Highlights

  • Closed loop insulin delivery technology has leapt in to the clinical space, but how do we use it?

Learning Objectives

  • Describe currently available (and potentially soon-to-be-available) devices
  • Demonstrate appropriate selection of patients and setting expectations
  • Demonstrate initial settings and best practices for implementation
  • Demonstrate therapeutic adjustments and special circumstances (exercise)

Practical Management of Pregestational Diabetes in Pregnancy

Highlights

  • Pregestational diabetes is increasingly common, yet treatment options are limited and optimal glycemic targets are stricter than outside of pregnancy

Learning Objectives

  • Describe short-term and long-term outcomes in the context of guideline-supported glycemic targets
  • Describe best-practice glucose testing and monitoring
  • Describe the role of non-insulin and insulin therapies in pregnancy

Fractures in Diabetes: Risk Factors, Assessment, and Clinical Recommendations

Highlights

  • Should we add osteoporosis to the list of complications of diabetes?

Learning Objectives

  • Diabetes as a risk for fracture
  • Understand physiology of diabetes that may impact fracture risk
  • Select patients with diabetes for screening and treatment
  • Follow up and treatment duration

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Obesity and Lipids

Lectures

Assessment of the Obese Patient

Highlights

  • Obesity is a common condition encountered in endocrine practice. It is challenging for busy clinicians to address this issue in a time efficient and effective manner. In this session, an expert in obesity management will provide practical tips that will help you make a real difference in the care of your patients with obesity.
  • An overview of how to initiate a conversation with an "overweight" patient and how to evaluate their needs by one of the true experts in the field

Learning Objectives

  • How to bring up and discuss obesity. Getting to the key topics of discussion quickly and effectively.
  • Identify the key comorbid conditions to look for in a patient with obesity and what steps to rule them in or out
  • How to talk to patients about the "cause of obesity" vs. focusing on goals and choices in therapy

What Have We Learned from the Look AHEAD Trial?

Highlights

  • The Look AHEAD trial was supposed to show that treating obesity reduced cardiovascular disease mortality. It did not show that. One of the principle investigators of this landmark study will help you appreciate what the study was and what the key take home lessons were.
  • What are the known predictors of weight loss success?
  • How much weight do you need to lose to improve various risk factors, reduce medication use, reduce inpatient and medication costs, improve symptoms of sleep apnea and reduce cardiovascular events?
  • Does weight loss exacerbate or improve depression? Do individuals with BMI 40+ benefit from weight loss as much as class I or class II obesity?
  • How can I equal the Look AHEAD results of 9% weight loss in year one without medications?
  • What are the known predictors of weight loss success?
  • What are the known predictors of weight loss success?
  • How can I avoid hypoglycemia when my patients with diabetes are trying to lose weight?

Learning Objectives

  • What was the Look AHEAD trial?
  • Did it show benefits? What were those benefits? Who benefited?
  • How do we use the results of this study in clinical practice?

Key Controversies in Lipidology

Highlights

  • Clinicians now are frequently faced with situations where it is not clear how to advise a patient with elevated lipid levels. In this session, a world-renowned expert will help you navigate the changing world of lipid guideline and the evolving approach to the treatment of hyperlipidemia.

Learning Objectives

Update on these key areas of controversy and implications for clinical practice:

  • Guidelines: How to make sense of guidelines that give different advice
  • Triglycerides and HDL: What to do about these in 2017
  • The role of PCSK-9 inhibitors and other new drugs in the pipeline
  • What about statins and diabetes?
  • Are saturated fats still the villains?

Meet-the-Professor (MTP) Sessions

Commercial Weight Loss Programs and Phone Apps

Highlights

  • In 2017, patients want to use electronic devices to help with all aspects of their life and weight loss is no exception. An expert in obesity treatment will help you know what to say to your patients who ask your advice about on line weight loss programs, diet apps, and exercise monitoring devices.
  • A blueprint for where to refer the patient who needs additional help or whether the health care professional doesn’t have the time or inclination to provide the "behavioral" message themselves.
  • These new approaches and gizmos are certainly popular but are they reason for hope, or just more hype? This session will review the randomized clinical trials that have evaluated commercial weight loss programs, wearables, and phone apps. Find out where you stand on recommending these to your patients trying to lose weight.

Learning Objectives

  • Summarize current data supporting or not supporting the use of commercial weight loss programs and phone apps for dietary modification or physical activity in the treatment of obesity

Behavioral Considerations in the Evaluation and Treatment of the Patient with Obesity

Highlights

  • While endocrinologists cannot be expected to provide comprehensive psychological services, we do regularly encounter depression, anxiety and alterations in body image in patients we are treating for obesity. Dr. O’Neil will help you to know what you can do to identify these conditions in your patients and treat in a manner appropriate for your practice.
  • A blueprint for the health care professional for what is needed to apply "behavior" in a clinical practice.

Learning Objectives

  • Evaluate and manage depression and anxiety in office practice management of the patient with obesity
  • Identify and manage eating disorders in the care of patients with obesity

Pharmacotherapy of Obesity

Highlights

  • Review of what we know about the use of weight loss medications in clinical practice in the context of past concerns and what is on the horizon

Learning Objectives

  • What drugs are currently approved for long-term treatment
  • How effective are they?
  • What do the side effect profiles compare?
  • Cases where drugs might be appropriate and which one to select

Bones and Stones After Bariatric Surgery

Highlights

  • An overview of the metabolic issues related to calcium that will occur when a very heavy individual loses a lot of weight and no longer needs the extra bone mass to carry around the lighter framework

Learning Objectives

  • Bone and calcium physiology after bariatric surgery
  • Perform an assessment of elevated PTH in a bariatric surgery patient
  • Fracture risk after bariatric surgery
  • Choose optimal supplements for bone health after bariatric surgery

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Reproductive Endocrinology

Lectures

Update on Female Contraception

Learning Objectives

  • New oral preparations/longer cycles
  • New options/selection of agents
  • Update on non-hormonal methods of contraception

PCOS Through the Lifespan

Learning Objectives

  • PCOS diagnosis
  • Fertility options
  • Minimizing long-term sequelae

Gender Dysphoria/Gender Incongruence: An Update on the Endocrine Society's New Clinical Practice Guideline

Learning Objectives

  • List significant changes in the evidence base for gender dysphoria/gender incongruence since publication of the previous Endocrine Society guideline on this topic
  • Identify significant changes in best practices that are being recommended in the 2017 gender dysphoria/gender incongruence guideline as a result of the changes in science
  • Identify gaps in the existing evidence base for gender dysphoria/gender incongruence which contribute to controversy or disagreement among clinicians about standards for optimal patient care

Treatment of Male Hypogonadism without Testosterone

Learning Objectives

  • Hypogonadism in obesity/sleep apnea
  • Alternatives to testosterone
  • Do any of the "natural" therapies work?

Male Infertility—What the Endocrinologist Needs to Know

Learning Objectives

  • Spermatogenesis induction in secondary hypogonadism
  • Clinical approach to male infertility
  • When to refer

Meet-the-Professor (MTP) Sessions

Hormone Replacement Therapy in Women

Learning Objectives

  • Selection of agents
  • When to start and when to stop
  • Minimizing side effects and complications

Hormone Replacement Therapy in Men

Learning Objectives

  • Selection of agents
  • Who should be treated
  • What about CVD or thrombotic risk?

Challenging Male Hypogonadism Cases

Learning Objectives

  • Hypogonadism in men with CVD
  • Hypogonadism treatment with fertility preservation

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Thyroid

Lectures

Molecular Markers for Thyroid Nodules and Cancer: Implications on Surgical Management and Follow-up

Highlights

  • The evolving role of molecular tests in the management of indeterminate nodules

Learning Objectives

  • Currently available tests
  • Indications for use of molecular tests and their impact on surgical planning
  • What do molecular tests tell us about NIFTP?

Subclinical Thyroid Disorders: Indications for Treatment

Highlights

  • An updated review of recent findings from the TRUST Study group and the Thyroid Studies Collaboration

Learning Objectives

  • Outline the long-term sequelae of untreated subclinical hypo- and hyperthyroidism
  • Indications for treatment of subclinical hyperthyroidism
  • Indications for treatment in subclinical hypothyroidism

Thyroid Disorders During Pregnancy

Highlights

  • A practical discussion of the important points in the pregnancy guidelines

Learning Objectives

  • How should the antibody positive pregnant patient be managed?
  • How should the clinician approach subclinical hypothyroidism in pregnancy?
  • When is thyroid hormone testing indicated in pregnancy?

Combination T4/T3 Therapy in Hypothyroidism

Highlights

  • How to discuss combination therapy (including natural desiccated thyroid hormone) with patients and overcome the internet bias and combat misinformation on the internet

Learning Objectives

  • Whether to treat
  • How to treat
  • Monitoring of labs

Meet-the-Professor (MTP) Sessions

Thyroid Nodules: Diagnosis and Management

Highlights

  • Not all nodules require FNA or follow-up

Learning Objectives

  • Sonographic stratification of thyroid nodules
  • When to biopsy thyroid nodules
  • How often and how long do nodules require surveillance?

Thyrotoxicosis: Different Treatment Options

Highlights

  • An insider's discussion of the hyperthyroidism guidelines

Learning Objectives

  • Indications for surgery and preoperative management
  • Adverse effects of ATDs and monitoring patients on them
  • Patient follow up after RAI therapy

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