ITALIAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS (AME) AND INTERNATIONAL CHAPTER OF CLINICAL ENDOCRINOLOGY (ICCE). POSITION STATEMENT FOR CLINICAL PRACTICE: PROLACTIN-SECRETING TUMORS

Prolactinomas are the most frequent pituitary adenomas. Prolactinoma may occur in different clinical settings and always require an individually tailored approach. This is the reason why a panel of Italian neuroendocrine experts was charged with the task to provide indications for the diagnostic and therapeutic approaches that can be easily applied in different contexts. The document provides 15 recommendations for diagnosis and 54 recommendations for treatment, issued according to the GRADE system. The level of agreement among panel members was formally evaluated by RAND-UCLA methodology. In the last century prolactinomas represented the paradigm of pituitary tumors for whom the development of highly effective drugs obtained the best results, allowing to avoid neurosurgery in most cases. The impressive improvement of neurosurgical endoscopic techniques allows a far better definition of the tumoral tissue during surgery and the remission of endocrine symptoms in many patients with pituitary tumors. Consequently, this refinement of neurosurgery is changing the therapeutic strategy in prolactinomas, allowing the definitive cure of some patients with permanent discontinuation of medical therapy.

American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool

<P>Objective: The first edition of the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 and updated in 2010 and 2016. The American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi multidisciplinary thyroid nodules task force was charged with developing a novel interactive electronic algorithmic tool to evaluate thyroid nodules. <P> Methods: The Thyroid Nodule App (termed TNAPP) was based on the updated 2016 clinical practice guideline recommendations while incorporating recent scientific evidence and avoiding unnecessary diagnostic procedures and surgical overtreatment. This manuscript describes the algorithmic tool development, its data requirements, and its basis for decision making. It provides links to the web-based algorithmic tool and a tutorial. <P> Results: TNAPP and TI-RADS were cross-checked on 95 thyroid nodules with histology-proven diagnoses. <P> Conclusion: TNAPP is a novel interactive web-based tool that uses clinical, imaging, cytologic, and molecular marker data to guide clinical decision making to evaluate and manage thyroid nodules. It may be used as a heuristic tool for evaluating and managing patients with thyroid nodules. It can be adapted to create registries for solo practices, large multispecialty delivery systems, regional and national databases, and research consortiums. Prospective studies are underway to validate TNAPP to determine how it compares with other ultrasound-based classification systems and whether it can improve the care of patients with clinically significant thyroid nodules while reducing the substantial burden incurred by those who do not benefit from further evaluation and treatment.</P>

Ruixia Pei’s Experience in the Treatment of Hypothyroidism

This study is to summarize Professor Pei’s experience in treating hypothyroidism. Professor Pei has been engaged in clinical endocrinology for more than 30 years and has unique insights into hypothyroidism. She believes that the disease is caused by liver depression, phlegm binding, yin deficiency, and fire effulgence. The basic principles of treatment are regulating Qi movement and harmonizing viscera. During treatment, the emphasis is on the influence of emotions on the disease. Both the liver and spleen should be given equal attention and the medication should be mild with balanced cold and heat.

Effects of Intermittent Fasting on the Circulating Levels and Circadian Rhythms of Hormones

Intermittent fasting has become an increasingly popular strategy in losing weight and associated reduction in obesity-related medical complications. Overwhelming studies support metabolic improvements from intermittent fasting in blood glucose levels, cardiac and brain function, and other health benefits, in addition to weight loss. However, concerns have also been raised on side effects including muscle loss, ketosis, and electrolyte imbalance. Of particular concern, the effect of intermittent fasting on hormonal circadian rhythms has received little attention. Given the known importance of circadian hormonal changes to normal physiology, potential detrimental effects by dysregulation of hormonal changes deserve careful discussions. In this review, we describe the changes in circadian rhythms of hormones caused by intermittent fasting. We covered major hormones commonly pathophysiologically involved in clinical endocrinology, including insulin, thyroid hormones, and glucocorticoids. Given that intermittent fasting could alter both the level and frequency of hormone secretion, decisions on practicing intermittent fasting should take more considerations on potential detrimental consequences versus beneficial effects pertaining to individual health conditions.

Clinical endocrinology of children and adolescents: in 2 parts Part 2

The textbook highlights the main pathological conditions in pediatric endocrinology, as well as their diagnosis and treatment. The materials for self-control and situational tasks are given. Meets the requirements of the federal state educational standards of higher education of the latest generation. For students, students of the postgraduate professional education system, pediatric endocrinologists, pediatricians, endocrinologists, internists and general practitioners.