Endo 2018

CHICAGO – An anti-inflammatory treatment targeting interleukin-1 receptors eased symptoms in hypogonadal men with obesity and metabolic syndrome,according to a study presented at the annual meeting of the Endocrine Society.

The treatment helps patients by targeting testosterone deficiency associated with metabolic syndrome as well as inflammation associated with hypogonadism.

“Antagonism of the interleukin inflammatory pathway led to improved endogenous testosterone production,” said presenter Fahim Ebrahimi, MD, of the University Hospital Basel, Switzerland. “Even with a clinical period so short, only 4 weeks, we have seen reduced blood pressure and increased grip strength.”

A total of 70 men with metabolic syndrome and hypergonadism from the University Hospital in Basel and Kantonsspital Aarau, Switzerland, were included in the randomized, double-blind, placebo-controlled study.

[email protected]

SOURCE: Ebrahimi F. et al. ENDO 2018, Abstract OR15-6.

CHICAGO – An anti-inflammatory treatment targeting interleukin-1 receptors eased symptoms in hypogonadal men with obesity and metabolic syndrome,according to a study presented at the annual meeting of the Endocrine Society.

The treatment helps patients by targeting testosterone deficiency associated with metabolic syndrome as well as inflammation associated with hypogonadism.

“Antagonism of the interleukin inflammatory pathway led to improved endogenous testosterone production,” said presenter Fahim Ebrahimi, MD, of the University Hospital Basel, Switzerland. “Even with a clinical period so short, only 4 weeks, we have seen reduced blood pressure and increased grip strength.”

A total of 70 men with metabolic syndrome and hypergonadism from the University Hospital in Basel and Kantonsspital Aarau, Switzerland, were included in the randomized, double-blind, placebo-controlled study.

[email protected]

SOURCE: Ebrahimi F. et al. ENDO 2018, Abstract OR15-6.

CHICAGO – An anti-inflammatory treatment targeting interleukin-1 receptors eased symptoms in hypogonadal men with obesity and metabolic syndrome,according to a study presented at the annual meeting of the Endocrine Society.

The treatment helps patients by targeting testosterone deficiency associated with metabolic syndrome as well as inflammation associated with hypogonadism.

“Antagonism of the interleukin inflammatory pathway led to improved endogenous testosterone production,” said presenter Fahim Ebrahimi, MD, of the University Hospital Basel, Switzerland. “Even with a clinical period so short, only 4 weeks, we have seen reduced blood pressure and increased grip strength.”

A total of 70 men with metabolic syndrome and hypergonadism from the University Hospital in Basel and Kantonsspital Aarau, Switzerland, were included in the randomized, double-blind, placebo-controlled study.

[email protected]

SOURCE: Ebrahimi F. et al. ENDO 2018, Abstract OR15-6.

CHICAGO – There is no “safe” lower glycemic threshold for pregnant women with diabetes below which adverse maternal and fetal/neonatal outcomes aren’t seen. In particular, “several retrospective studies have shown that the risk for congenital malformations is increased with higher hemoglobin A_1c levels,” said Susan Kirk, MD, speaking at a “Meet the Professor” session at the annual meeting of the Endocrine Society.

However, pointed out Dr. Kirk, fact-based counseling about pregnancy risks for women with type 1 or type 2 diabetes can – and should – occur within the framework of a strong and accepting physician-patient relationship.

Most women with diabetes have received pre-conception counseling about the risks of pregnancy with diabetes and the importance of glycemic control. “Despite that, I think many of us are often surprised by the percentage of unplanned pregnancies,” said Dr. Kirk, of the University of Virginia, Charlottesville, in an interview.

“What I have learned is that the desire to become pregnant is so strong, and the contemplation of all the adverse events that can happen … is really scary, not only to the woman but to her partner as well.”

Dr. Kirk continued, “The more compassion you can show, and the more emphasis that you can place on the fact that she’s most likely to have a healthy baby, the chances are she’ll work with you from the beginning to get her control where she needs to be.”

Target numbers for hemoglobin A_1c have become lower over the past several years, with the American Diabetes Association now recommending pre-conception levels below 6.5%. “There’s no randomized controlled trial that defines what that ideal number should be, but with the passage of time and some larger studies, we now know that ‘as close to normal as possible’ should be the goal,” Dr. Kirk said. This means that if women can tolerate the lower blood glucose levels without serious symptoms of hypoglycemia, a level of less than 6% is more preferable still, she said.

In terms of medication management for women with diabetes who become pregnant, physicians need to think about angiotensin converting enzyme inhibitors and statins, both of which are contraindicated for use during pregnancy. If a patient is pregnant or trying for a pregnancy, “I will stop those, and either leave them off all medicine entirely, or transition them to something that’s safe for use during pregnancy,” said Dr. Kirk.

[email protected]

SOURCE: Kirk S. ENDO 2018, Session M-02-3.

CHICAGO – There is no “safe” lower glycemic threshold for pregnant women with diabetes below which adverse maternal and fetal/neonatal outcomes aren’t seen. In particular, “several retrospective studies have shown that the risk for congenital malformations is increased with higher hemoglobin A_1c levels,” said Susan Kirk, MD, speaking at a “Meet the Professor” session at the annual meeting of the Endocrine Society.

However, pointed out Dr. Kirk, fact-based counseling about pregnancy risks for women with type 1 or type 2 diabetes can – and should – occur within the framework of a strong and accepting physician-patient relationship.

Most women with diabetes have received pre-conception counseling about the risks of pregnancy with diabetes and the importance of glycemic control. “Despite that, I think many of us are often surprised by the percentage of unplanned pregnancies,” said Dr. Kirk, of the University of Virginia, Charlottesville, in an interview.

“What I have learned is that the desire to become pregnant is so strong, and the contemplation of all the adverse events that can happen … is really scary, not only to the woman but to her partner as well.”

Dr. Kirk continued, “The more compassion you can show, and the more emphasis that you can place on the fact that she’s most likely to have a healthy baby, the chances are she’ll work with you from the beginning to get her control where she needs to be.”

Target numbers for hemoglobin A_1c have become lower over the past several years, with the American Diabetes Association now recommending pre-conception levels below 6.5%. “There’s no randomized controlled trial that defines what that ideal number should be, but with the passage of time and some larger studies, we now know that ‘as close to normal as possible’ should be the goal,” Dr. Kirk said. This means that if women can tolerate the lower blood glucose levels without serious symptoms of hypoglycemia, a level of less than 6% is more preferable still, she said.

In terms of medication management for women with diabetes who become pregnant, physicians need to think about angiotensin converting enzyme inhibitors and statins, both of which are contraindicated for use during pregnancy. If a patient is pregnant or trying for a pregnancy, “I will stop those, and either leave them off all medicine entirely, or transition them to something that’s safe for use during pregnancy,” said Dr. Kirk.

[email protected]

SOURCE: Kirk S. ENDO 2018, Session M-02-3.

CHICAGO – There is no “safe” lower glycemic threshold for pregnant women with diabetes below which adverse maternal and fetal/neonatal outcomes aren’t seen. In particular, “several retrospective studies have shown that the risk for congenital malformations is increased with higher hemoglobin A_1c levels,” said Susan Kirk, MD, speaking at a “Meet the Professor” session at the annual meeting of the Endocrine Society.

However, pointed out Dr. Kirk, fact-based counseling about pregnancy risks for women with type 1 or type 2 diabetes can – and should – occur within the framework of a strong and accepting physician-patient relationship.

Most women with diabetes have received pre-conception counseling about the risks of pregnancy with diabetes and the importance of glycemic control. “Despite that, I think many of us are often surprised by the percentage of unplanned pregnancies,” said Dr. Kirk, of the University of Virginia, Charlottesville, in an interview.

“What I have learned is that the desire to become pregnant is so strong, and the contemplation of all the adverse events that can happen … is really scary, not only to the woman but to her partner as well.”

Dr. Kirk continued, “The more compassion you can show, and the more emphasis that you can place on the fact that she’s most likely to have a healthy baby, the chances are she’ll work with you from the beginning to get her control where she needs to be.”

Target numbers for hemoglobin A_1c have become lower over the past several years, with the American Diabetes Association now recommending pre-conception levels below 6.5%. “There’s no randomized controlled trial that defines what that ideal number should be, but with the passage of time and some larger studies, we now know that ‘as close to normal as possible’ should be the goal,” Dr. Kirk said. This means that if women can tolerate the lower blood glucose levels without serious symptoms of hypoglycemia, a level of less than 6% is more preferable still, she said.

In terms of medication management for women with diabetes who become pregnant, physicians need to think about angiotensin converting enzyme inhibitors and statins, both of which are contraindicated for use during pregnancy. If a patient is pregnant or trying for a pregnancy, “I will stop those, and either leave them off all medicine entirely, or transition them to something that’s safe for use during pregnancy,” said Dr. Kirk.

[email protected]

SOURCE: Kirk S. ENDO 2018, Session M-02-3.

CHICAGO – Certain serum microRNA profiles hold promise for postsurgery monitoring of patients with papillary thyroid cancer, according to Francesca Rosignolo, PhD, of the University of Rome.

The usual tool for trying to detect recurrence while following patients with papillary thyroid cancer after surgery has been the serum thyroglobulin assay. However, management of papillary thyroid cancer has become more conservative, involving lobectomy and isthmusectomy on the affected side rather than total gland resection. The benefit of the conservative approach is to avoid complications while maintaining an overall survival rate equivalent to the more extensive approach.

The investigators measured 754 miRNAs in serum samples of 11 patients with papillary thyroid cancer both before and 30 days after surgical thyroidectomy. They re-evaluated major candidate miRNAs using absolute quantitative polymerase chain reaction analysis in an independent cohort of 44 other patients with papillary thyroid cancer or benign nodules or 20 healthy controls, Dr. Rosignolo said at the annual meeting of the Endocrine Society.

The 2 miRNAs most significantly associated with thyroid tumors were then assessed in matched serum samples (before and 30 days, and 1 to 2 years after surgery) from the 20 PTC patients with complete follow-up datasets and results correlated with American Thyroid Association (ATA) responses to therapy.

[email protected]

SOURCE: Rosignolo F et al. J Endo Soc. 2017;1(1)3-13. ENDO 2018, Abstract OR17-1.

CHICAGO – Certain serum microRNA profiles hold promise for postsurgery monitoring of patients with papillary thyroid cancer, according to Francesca Rosignolo, PhD, of the University of Rome.

The usual tool for trying to detect recurrence while following patients with papillary thyroid cancer after surgery has been the serum thyroglobulin assay. However, management of papillary thyroid cancer has become more conservative, involving lobectomy and isthmusectomy on the affected side rather than total gland resection. The benefit of the conservative approach is to avoid complications while maintaining an overall survival rate equivalent to the more extensive approach.

The investigators measured 754 miRNAs in serum samples of 11 patients with papillary thyroid cancer both before and 30 days after surgical thyroidectomy. They re-evaluated major candidate miRNAs using absolute quantitative polymerase chain reaction analysis in an independent cohort of 44 other patients with papillary thyroid cancer or benign nodules or 20 healthy controls, Dr. Rosignolo said at the annual meeting of the Endocrine Society.

The 2 miRNAs most significantly associated with thyroid tumors were then assessed in matched serum samples (before and 30 days, and 1 to 2 years after surgery) from the 20 PTC patients with complete follow-up datasets and results correlated with American Thyroid Association (ATA) responses to therapy.

[email protected]

SOURCE: Rosignolo F et al. J Endo Soc. 2017;1(1)3-13. ENDO 2018, Abstract OR17-1.

CHICAGO – Certain serum microRNA profiles hold promise for postsurgery monitoring of patients with papillary thyroid cancer, according to Francesca Rosignolo, PhD, of the University of Rome.

The usual tool for trying to detect recurrence while following patients with papillary thyroid cancer after surgery has been the serum thyroglobulin assay. However, management of papillary thyroid cancer has become more conservative, involving lobectomy and isthmusectomy on the affected side rather than total gland resection. The benefit of the conservative approach is to avoid complications while maintaining an overall survival rate equivalent to the more extensive approach.

The investigators measured 754 miRNAs in serum samples of 11 patients with papillary thyroid cancer both before and 30 days after surgical thyroidectomy. They re-evaluated major candidate miRNAs using absolute quantitative polymerase chain reaction analysis in an independent cohort of 44 other patients with papillary thyroid cancer or benign nodules or 20 healthy controls, Dr. Rosignolo said at the annual meeting of the Endocrine Society.

The 2 miRNAs most significantly associated with thyroid tumors were then assessed in matched serum samples (before and 30 days, and 1 to 2 years after surgery) from the 20 PTC patients with complete follow-up datasets and results correlated with American Thyroid Association (ATA) responses to therapy.

[email protected]

SOURCE: Rosignolo F et al. J Endo Soc. 2017;1(1)3-13. ENDO 2018, Abstract OR17-1.

CHICAGO – Levels of thyroid stimulating hormone were significantly higher in women with unexplained infertility than in a cohort whose partners had severe male factor infertility, though TSH levels still fell within the reference range.

For women with unexplained infertility, thyroid stimulating hormone (TSH) averaged 1.95 mIU/mL (95% confidence interval, 1.54-2.61), compared with 1.66 mIU/mL for the group of women with severe male factor infertility, such as severe oligospermia or azoospermia (95% CI, 1.25-2.17; P = .003).

“We found, very interestingly, that in the unexplained group, TSH was higher in those women, compared with women whose partners had severe male factor infertility,” suggesting that TSH is a contributor to the otherwise unexplained infertility, the study’s first author, Lindsay T. Fourman, MD, said in an interview at the annual meeting of the Endocrine Society.

In terms of TSH levels, “clearly, the cutoff of the upper limit of the normal range is controversial,” said Dr. Fourman. “Some studies have shown that 95% of the population has a TSH of less than 2.5.”

“Current guidelines do not recommend treatment of subclinical hypothyroidism among auto-antibody negative women attempting to conceive naturally,” wrote Dr. Fourman and her collaborators in the poster presenting their finding.

Twice as many women in the group with unexplained infertility had TSH levels in the upper half of the normal range – above 2.5 mIU/mL – than in the male factor infertility group, “again, suggesting this association with TSH and unexplained infertility,” Dr. Fourman said. The thyroid axis is known to play a role in oocyte development. Of women with unexplained infertility, 26.9% had a TSH above 5 mIU/mL, compared with 13.5% of those with severe male factor infertility (P less than .05).

Dr. Fourman acknowledged that she and her and her collaborators couldn’t exclude some female factor infertility among the control group. “That is an assumption, but it’s an assumption that would bias us to the null,” strengthening the study’s findings.

Clinical characteristics were similar between study groups, though women with unexplained infertility were slightly older than those with severe male factor infertility (mean 31.5 years versus 30.1 years, P = .01); they also had slightly lower body mass indices (median 23 versus 24.4 kg/m²; P less than .04).

No association was found between prolactin levels, “which suggests that prolactin may not contribute to unexplained infertility in these women,” Dr. Fourman said.

The investigators were able to control for such potentially confounding variables as age, tobacco use, BMI; they excluded from analysis women who had positive thyroid peroxidase antibodies.

“This is very interesting, because it really raises the question of whether we should be treating TSH, even to the lower half of the normal range, to see if that can improve outcomes,” she said. “We are looking for modifiable things that we can treat to try to improve fertility, so if we can identify some cause – like a hormonal cause – we may be able to improve conception outcomes and reduce the need for invasive treatment.”

Based in part on the strength of these findings, Dr. Fourman said she and her collaborators are planning a prospective study to see whether treating women with infertility to achieve a TSH of less than 2.5 can speed time to conception and reduce the need for invasive infertility treatment.

Dr. Fourman reported no conflicts of interest and no external sources of funding.

[email protected]

SOURCE: Fourman, L, et al. ENDO 2018, Abstract SAT-288.

CHICAGO – Levels of thyroid stimulating hormone were significantly higher in women with unexplained infertility than in a cohort whose partners had severe male factor infertility, though TSH levels still fell within the reference range.

For women with unexplained infertility, thyroid stimulating hormone (TSH) averaged 1.95 mIU/mL (95% confidence interval, 1.54-2.61), compared with 1.66 mIU/mL for the group of women with severe male factor infertility, such as severe oligospermia or azoospermia (95% CI, 1.25-2.17; P = .003).

“We found, very interestingly, that in the unexplained group, TSH was higher in those women, compared with women whose partners had severe male factor infertility,” suggesting that TSH is a contributor to the otherwise unexplained infertility, the study’s first author, Lindsay T. Fourman, MD, said in an interview at the annual meeting of the Endocrine Society.

In terms of TSH levels, “clearly, the cutoff of the upper limit of the normal range is controversial,” said Dr. Fourman. “Some studies have shown that 95% of the population has a TSH of less than 2.5.”

“Current guidelines do not recommend treatment of subclinical hypothyroidism among auto-antibody negative women attempting to conceive naturally,” wrote Dr. Fourman and her collaborators in the poster presenting their finding.

Twice as many women in the group with unexplained infertility had TSH levels in the upper half of the normal range – above 2.5 mIU/mL – than in the male factor infertility group, “again, suggesting this association with TSH and unexplained infertility,” Dr. Fourman said. The thyroid axis is known to play a role in oocyte development. Of women with unexplained infertility, 26.9% had a TSH above 5 mIU/mL, compared with 13.5% of those with severe male factor infertility (P less than .05).

Dr. Fourman acknowledged that she and her and her collaborators couldn’t exclude some female factor infertility among the control group. “That is an assumption, but it’s an assumption that would bias us to the null,” strengthening the study’s findings.

Clinical characteristics were similar between study groups, though women with unexplained infertility were slightly older than those with severe male factor infertility (mean 31.5 years versus 30.1 years, P = .01); they also had slightly lower body mass indices (median 23 versus 24.4 kg/m²; P less than .04).

No association was found between prolactin levels, “which suggests that prolactin may not contribute to unexplained infertility in these women,” Dr. Fourman said.

The investigators were able to control for such potentially confounding variables as age, tobacco use, BMI; they excluded from analysis women who had positive thyroid peroxidase antibodies.

“This is very interesting, because it really raises the question of whether we should be treating TSH, even to the lower half of the normal range, to see if that can improve outcomes,” she said. “We are looking for modifiable things that we can treat to try to improve fertility, so if we can identify some cause – like a hormonal cause – we may be able to improve conception outcomes and reduce the need for invasive treatment.”

Based in part on the strength of these findings, Dr. Fourman said she and her collaborators are planning a prospective study to see whether treating women with infertility to achieve a TSH of less than 2.5 can speed time to conception and reduce the need for invasive infertility treatment.

Dr. Fourman reported no conflicts of interest and no external sources of funding.

[email protected]

SOURCE: Fourman, L, et al. ENDO 2018, Abstract SAT-288.

CHICAGO – Levels of thyroid stimulating hormone were significantly higher in women with unexplained infertility than in a cohort whose partners had severe male factor infertility, though TSH levels still fell within the reference range.

For women with unexplained infertility, thyroid stimulating hormone (TSH) averaged 1.95 mIU/mL (95% confidence interval, 1.54-2.61), compared with 1.66 mIU/mL for the group of women with severe male factor infertility, such as severe oligospermia or azoospermia (95% CI, 1.25-2.17; P = .003).

“We found, very interestingly, that in the unexplained group, TSH was higher in those women, compared with women whose partners had severe male factor infertility,” suggesting that TSH is a contributor to the otherwise unexplained infertility, the study’s first author, Lindsay T. Fourman, MD, said in an interview at the annual meeting of the Endocrine Society.

In terms of TSH levels, “clearly, the cutoff of the upper limit of the normal range is controversial,” said Dr. Fourman. “Some studies have shown that 95% of the population has a TSH of less than 2.5.”

“Current guidelines do not recommend treatment of subclinical hypothyroidism among auto-antibody negative women attempting to conceive naturally,” wrote Dr. Fourman and her collaborators in the poster presenting their finding.

Twice as many women in the group with unexplained infertility had TSH levels in the upper half of the normal range – above 2.5 mIU/mL – than in the male factor infertility group, “again, suggesting this association with TSH and unexplained infertility,” Dr. Fourman said. The thyroid axis is known to play a role in oocyte development. Of women with unexplained infertility, 26.9% had a TSH above 5 mIU/mL, compared with 13.5% of those with severe male factor infertility (P less than .05).

Dr. Fourman acknowledged that she and her and her collaborators couldn’t exclude some female factor infertility among the control group. “That is an assumption, but it’s an assumption that would bias us to the null,” strengthening the study’s findings.

Clinical characteristics were similar between study groups, though women with unexplained infertility were slightly older than those with severe male factor infertility (mean 31.5 years versus 30.1 years, P = .01); they also had slightly lower body mass indices (median 23 versus 24.4 kg/m²; P less than .04).

No association was found between prolactin levels, “which suggests that prolactin may not contribute to unexplained infertility in these women,” Dr. Fourman said.

The investigators were able to control for such potentially confounding variables as age, tobacco use, BMI; they excluded from analysis women who had positive thyroid peroxidase antibodies.

“This is very interesting, because it really raises the question of whether we should be treating TSH, even to the lower half of the normal range, to see if that can improve outcomes,” she said. “We are looking for modifiable things that we can treat to try to improve fertility, so if we can identify some cause – like a hormonal cause – we may be able to improve conception outcomes and reduce the need for invasive treatment.”

Based in part on the strength of these findings, Dr. Fourman said she and her collaborators are planning a prospective study to see whether treating women with infertility to achieve a TSH of less than 2.5 can speed time to conception and reduce the need for invasive infertility treatment.

Dr. Fourman reported no conflicts of interest and no external sources of funding.

[email protected]

SOURCE: Fourman, L, et al. ENDO 2018, Abstract SAT-288.

CHICAGO – Spreading calories out over three regular meals a day, instead of six small ones, helps patients with type 2 diabetes lose weight and better control their blood glucose, especially when breakfast is the main meal of the day, according to Israeli investigators.

Too often, obese type 2 patients end up on a treadmill of ever-increasing insulin doses that lead, in turn, to more weight gain and still more insulin, plus greater risk of diabetic complications. “To break this vicious cycle, we need to better control diabetes with less insulin,” said lead investigator Daniela Jakubowicz, MD, an endocrinologist at the Wolfson Medical Center at Tel Aviv University.

The team had a hunch that meal-timing would help, so they randomized 19 obese, uncontrolled type 2 patients to three meals a day, and 18 to six meals. The overall calories were the same in each arm: 1,500-1,800 per day.

[email protected]

SOURCE: Jakubowicz D et al. ENDO 2018, Abstract OR05-2.

CHICAGO – Spreading calories out over three regular meals a day, instead of six small ones, helps patients with type 2 diabetes lose weight and better control their blood glucose, especially when breakfast is the main meal of the day, according to Israeli investigators.

Too often, obese type 2 patients end up on a treadmill of ever-increasing insulin doses that lead, in turn, to more weight gain and still more insulin, plus greater risk of diabetic complications. “To break this vicious cycle, we need to better control diabetes with less insulin,” said lead investigator Daniela Jakubowicz, MD, an endocrinologist at the Wolfson Medical Center at Tel Aviv University.

The team had a hunch that meal-timing would help, so they randomized 19 obese, uncontrolled type 2 patients to three meals a day, and 18 to six meals. The overall calories were the same in each arm: 1,500-1,800 per day.

[email protected]

SOURCE: Jakubowicz D et al. ENDO 2018, Abstract OR05-2.

CHICAGO – Spreading calories out over three regular meals a day, instead of six small ones, helps patients with type 2 diabetes lose weight and better control their blood glucose, especially when breakfast is the main meal of the day, according to Israeli investigators.

Too often, obese type 2 patients end up on a treadmill of ever-increasing insulin doses that lead, in turn, to more weight gain and still more insulin, plus greater risk of diabetic complications. “To break this vicious cycle, we need to better control diabetes with less insulin,” said lead investigator Daniela Jakubowicz, MD, an endocrinologist at the Wolfson Medical Center at Tel Aviv University.

The team had a hunch that meal-timing would help, so they randomized 19 obese, uncontrolled type 2 patients to three meals a day, and 18 to six meals. The overall calories were the same in each arm: 1,500-1,800 per day.

[email protected]

SOURCE: Jakubowicz D et al. ENDO 2018, Abstract OR05-2.

CHICAGO – Patients with adrenal cortical carcinoma (ACC) who opt for surgery are predicted to survive significantly longer than those who choose chemotherapy or radiation at all stages, according to a study presented at the annual meeting of the Endocrine Society.

These findings, uncovered using the largest cancer registry in the United States, will help give physicians insight into what the best course of action is for treating their patients, according to presenters.

“Surgical resection of the primary tumor improved survival in all stages of disease, whereas adjuvant therapy with chemotherapy or radiation improved overall survival only in stage IVpatients,” said Sri Harsha Tella, MD, endocrinologist at the University of South Carolina, Columbia. “These results may help the prognostication of patients in treatment decision making.”

Investigators conducted a retrospective study of 3,185 pathologically confirmed cases of ACC, registered into the National Cancer Database between 2004 and 2015.

[email protected]

SOURCE: Tella SH et al. Endo 2018.

CHICAGO – Patients with adrenal cortical carcinoma (ACC) who opt for surgery are predicted to survive significantly longer than those who choose chemotherapy or radiation at all stages, according to a study presented at the annual meeting of the Endocrine Society.

These findings, uncovered using the largest cancer registry in the United States, will help give physicians insight into what the best course of action is for treating their patients, according to presenters.

“Surgical resection of the primary tumor improved survival in all stages of disease, whereas adjuvant therapy with chemotherapy or radiation improved overall survival only in stage IVpatients,” said Sri Harsha Tella, MD, endocrinologist at the University of South Carolina, Columbia. “These results may help the prognostication of patients in treatment decision making.”

Investigators conducted a retrospective study of 3,185 pathologically confirmed cases of ACC, registered into the National Cancer Database between 2004 and 2015.

[email protected]

SOURCE: Tella SH et al. Endo 2018.

CHICAGO – Patients with adrenal cortical carcinoma (ACC) who opt for surgery are predicted to survive significantly longer than those who choose chemotherapy or radiation at all stages, according to a study presented at the annual meeting of the Endocrine Society.

These findings, uncovered using the largest cancer registry in the United States, will help give physicians insight into what the best course of action is for treating their patients, according to presenters.

“Surgical resection of the primary tumor improved survival in all stages of disease, whereas adjuvant therapy with chemotherapy or radiation improved overall survival only in stage IVpatients,” said Sri Harsha Tella, MD, endocrinologist at the University of South Carolina, Columbia. “These results may help the prognostication of patients in treatment decision making.”

Investigators conducted a retrospective study of 3,185 pathologically confirmed cases of ACC, registered into the National Cancer Database between 2004 and 2015.

[email protected]

SOURCE: Tella SH et al. Endo 2018.

CHICAGO – Exclusive use of labs that have been accredited by the Centers for Disease Control and Prevention in performing free testosterone assays is one addition to the evaluation of men with suspected hypogonadism that is included in the revised clinical practice guideline on testosterone therapy in men with hypogonadism, issued March 17 by the Endocrine Society. The previous guideline was issued in 2010.

“Since 2010, the CDC has provided an accuracy-based standardization program for T (CDC Hormone Standardization Program for Testosterone). Although several commercial laboratories, some assay manufacturers, and some academic laboratories are now CDC certified, most T immunoassay kit manufacturers and local hospital-based laboratories have not been certified. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for TT generally offer higher concentrations of specificity, sensitivity, and precision (especially in the low range) than do most immunoassays. Clinicians should ideally measure TT using a CDC-certified assay or an assay verified by an accuracy-based external quality control program,” according to the guideline.

Diagnosis, treatment, and follow-up of men with suspected hypogonadism often involve nuanced decisions, according to guideline panel chair Shalender Bhasin, MB, an endocrinologist who is professor of medicine at both Harvard Medical School and Brigham and Women’s Hospital, in Boston. The guideline will be published in its entirety in the May 2018 print issue of The Journal of Clinical Endocrinology & Metabolism.

[email protected]

SOURCE: ENDO 2018

CHICAGO – Exclusive use of labs that have been accredited by the Centers for Disease Control and Prevention in performing free testosterone assays is one addition to the evaluation of men with suspected hypogonadism that is included in the revised clinical practice guideline on testosterone therapy in men with hypogonadism, issued March 17 by the Endocrine Society. The previous guideline was issued in 2010.

“Since 2010, the CDC has provided an accuracy-based standardization program for T (CDC Hormone Standardization Program for Testosterone). Although several commercial laboratories, some assay manufacturers, and some academic laboratories are now CDC certified, most T immunoassay kit manufacturers and local hospital-based laboratories have not been certified. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for TT generally offer higher concentrations of specificity, sensitivity, and precision (especially in the low range) than do most immunoassays. Clinicians should ideally measure TT using a CDC-certified assay or an assay verified by an accuracy-based external quality control program,” according to the guideline.

Diagnosis, treatment, and follow-up of men with suspected hypogonadism often involve nuanced decisions, according to guideline panel chair Shalender Bhasin, MB, an endocrinologist who is professor of medicine at both Harvard Medical School and Brigham and Women’s Hospital, in Boston. The guideline will be published in its entirety in the May 2018 print issue of The Journal of Clinical Endocrinology & Metabolism.

[email protected]

SOURCE: ENDO 2018

CHICAGO – Exclusive use of labs that have been accredited by the Centers for Disease Control and Prevention in performing free testosterone assays is one addition to the evaluation of men with suspected hypogonadism that is included in the revised clinical practice guideline on testosterone therapy in men with hypogonadism, issued March 17 by the Endocrine Society. The previous guideline was issued in 2010.

“Since 2010, the CDC has provided an accuracy-based standardization program for T (CDC Hormone Standardization Program for Testosterone). Although several commercial laboratories, some assay manufacturers, and some academic laboratories are now CDC certified, most T immunoassay kit manufacturers and local hospital-based laboratories have not been certified. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for TT generally offer higher concentrations of specificity, sensitivity, and precision (especially in the low range) than do most immunoassays. Clinicians should ideally measure TT using a CDC-certified assay or an assay verified by an accuracy-based external quality control program,” according to the guideline.

Diagnosis, treatment, and follow-up of men with suspected hypogonadism often involve nuanced decisions, according to guideline panel chair Shalender Bhasin, MB, an endocrinologist who is professor of medicine at both Harvard Medical School and Brigham and Women’s Hospital, in Boston. The guideline will be published in its entirety in the May 2018 print issue of The Journal of Clinical Endocrinology & Metabolism.

[email protected]

SOURCE: ENDO 2018

Endocrinology on a chip in the shape of the EVATAR hardware program will yield new and helpful insights into how female reproductive organs communicate with each other and the liver via the endocrine system.

The project was first funded in 2012 by a National Institutes of Health grant that aimed to spur development of experimental hardware, and now researchers at Northwestern University, Chicago, headed by Teresa K. Woodruff, PhD, have bioengineered a 3-D model of the female reproductive tract and the liver using living cells and tissues. The resulting model is small enough to fit in the palm of your hand.

“Cells in aggregate organs are in constant communication with each other and the conversation is provided by the endocrine system. This is a completely new era in biology helping us illuminate disease systems we could not otherwise, such as polycystic ovary disease [PCOS],” said Dr. Woodruff, who is the Thomas J. Watkins Memorial professor of obstetrics and gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University.

Until the development of EVATAR, there was no good animal or other model of female reproductive diseases, such as cancer, PCOS, and infertility.

The EVATAR 3-D system is composed of plastic cubes, each representing the target organs of the female reproductive tract. The tissue lining each cube is assembled from multiple cell lineages to create individual follicles that enclose and support oocytes, oviductal/fallopian tubes, uterine myometrium and endometrium, the cervix, and the vagina. The cubes are then connected with tiny tubes, so that the fluid representing human blood and the hormones contained therein can flow between each of the cube compartments.

The EVATAR also contains cells from the liver. Using this system, researchers can study the effects of drugs on the female reproductive system and examine the drug metabolites in the liver.

Variations on EVATAR currently in development include 3-D models of the male reproductive system, dubbed “Guy in a Cube,” she quipped.

Endocrinology on a chip in the shape of the EVATAR hardware program will yield new and helpful insights into how female reproductive organs communicate with each other and the liver via the endocrine system.

The project was first funded in 2012 by a National Institutes of Health grant that aimed to spur development of experimental hardware, and now researchers at Northwestern University, Chicago, headed by Teresa K. Woodruff, PhD, have bioengineered a 3-D model of the female reproductive tract and the liver using living cells and tissues. The resulting model is small enough to fit in the palm of your hand.

“Cells in aggregate organs are in constant communication with each other and the conversation is provided by the endocrine system. This is a completely new era in biology helping us illuminate disease systems we could not otherwise, such as polycystic ovary disease [PCOS],” said Dr. Woodruff, who is the Thomas J. Watkins Memorial professor of obstetrics and gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University.

Until the development of EVATAR, there was no good animal or other model of female reproductive diseases, such as cancer, PCOS, and infertility.

The EVATAR 3-D system is composed of plastic cubes, each representing the target organs of the female reproductive tract. The tissue lining each cube is assembled from multiple cell lineages to create individual follicles that enclose and support oocytes, oviductal/fallopian tubes, uterine myometrium and endometrium, the cervix, and the vagina. The cubes are then connected with tiny tubes, so that the fluid representing human blood and the hormones contained therein can flow between each of the cube compartments.

The EVATAR also contains cells from the liver. Using this system, researchers can study the effects of drugs on the female reproductive system and examine the drug metabolites in the liver.

Variations on EVATAR currently in development include 3-D models of the male reproductive system, dubbed “Guy in a Cube,” she quipped.

Endocrinology on a chip in the shape of the EVATAR hardware program will yield new and helpful insights into how female reproductive organs communicate with each other and the liver via the endocrine system.

The project was first funded in 2012 by a National Institutes of Health grant that aimed to spur development of experimental hardware, and now researchers at Northwestern University, Chicago, headed by Teresa K. Woodruff, PhD, have bioengineered a 3-D model of the female reproductive tract and the liver using living cells and tissues. The resulting model is small enough to fit in the palm of your hand.

“Cells in aggregate organs are in constant communication with each other and the conversation is provided by the endocrine system. This is a completely new era in biology helping us illuminate disease systems we could not otherwise, such as polycystic ovary disease [PCOS],” said Dr. Woodruff, who is the Thomas J. Watkins Memorial professor of obstetrics and gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University.

Until the development of EVATAR, there was no good animal or other model of female reproductive diseases, such as cancer, PCOS, and infertility.

The EVATAR 3-D system is composed of plastic cubes, each representing the target organs of the female reproductive tract. The tissue lining each cube is assembled from multiple cell lineages to create individual follicles that enclose and support oocytes, oviductal/fallopian tubes, uterine myometrium and endometrium, the cervix, and the vagina. The cubes are then connected with tiny tubes, so that the fluid representing human blood and the hormones contained therein can flow between each of the cube compartments.

The EVATAR also contains cells from the liver. Using this system, researchers can study the effects of drugs on the female reproductive system and examine the drug metabolites in the liver.

Variations on EVATAR currently in development include 3-D models of the male reproductive system, dubbed “Guy in a Cube,” she quipped.

When it comes to populating deep space, “we want to learn the rules of the road” by studying the effects of space radiation and other factors on male and female fertility, according to Teresa K. Woodruff, PhD, the Thomas J. Watkins Memorial Professor of Obstetrics & Gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University, Chicago, who is chairing a session on March 17 at the 2018 Endocrine Society annual meeting entitled: “Mission to Mars.”

NASA/Greg Shirah

The project was developed based on the anticipation that “we will continue to explore space as an inhabitable frontier.” The talks in this session will examine endocrine-based reproduction such as sperm function and biologic fertilization that has occurred in space, noted Dr. Woodruff, who is also professor of molecular biosciences in the Weinberg College of Arts and Sciences and professor of biomedical engineering in the McCormick School of Engineering, both at Northwestern University.

Dr. Woodruff currently has a grant under review by the National Aeronautics and Space Administration that is relevant to the mission of populating space. “If we are going to populate space, which we will need to do based on the length of time we will be there, we are going to have to get gametes into space,” she said. There will be more and more research effort focused on the needs of the humans who are “non-Earth dwelling,” she said.

The next step might be to study embryo development in that environment. Such research would take place at the International Space Station.

“I am interested in endocrine disruptors. What we learn from the study of the challenges to reproduction in space we will be able to apply on earth,” Dr. Woodruff said.

Also on the panel will be Joseph S. Tash, PhD, of Kansas University, Kansas City, whose grant on Space Flight Impacts on Gonadal and Gamete Function already has NASA funding, according to Dr. Woodruff.

When it comes to populating deep space, “we want to learn the rules of the road” by studying the effects of space radiation and other factors on male and female fertility, according to Teresa K. Woodruff, PhD, the Thomas J. Watkins Memorial Professor of Obstetrics & Gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University, Chicago, who is chairing a session on March 17 at the 2018 Endocrine Society annual meeting entitled: “Mission to Mars.”

NASA/Greg Shirah

The project was developed based on the anticipation that “we will continue to explore space as an inhabitable frontier.” The talks in this session will examine endocrine-based reproduction such as sperm function and biologic fertilization that has occurred in space, noted Dr. Woodruff, who is also professor of molecular biosciences in the Weinberg College of Arts and Sciences and professor of biomedical engineering in the McCormick School of Engineering, both at Northwestern University.

Dr. Woodruff currently has a grant under review by the National Aeronautics and Space Administration that is relevant to the mission of populating space. “If we are going to populate space, which we will need to do based on the length of time we will be there, we are going to have to get gametes into space,” she said. There will be more and more research effort focused on the needs of the humans who are “non-Earth dwelling,” she said.

The next step might be to study embryo development in that environment. Such research would take place at the International Space Station.

“I am interested in endocrine disruptors. What we learn from the study of the challenges to reproduction in space we will be able to apply on earth,” Dr. Woodruff said.

Also on the panel will be Joseph S. Tash, PhD, of Kansas University, Kansas City, whose grant on Space Flight Impacts on Gonadal and Gamete Function already has NASA funding, according to Dr. Woodruff.

When it comes to populating deep space, “we want to learn the rules of the road” by studying the effects of space radiation and other factors on male and female fertility, according to Teresa K. Woodruff, PhD, the Thomas J. Watkins Memorial Professor of Obstetrics & Gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University, Chicago, who is chairing a session on March 17 at the 2018 Endocrine Society annual meeting entitled: “Mission to Mars.”

NASA/Greg Shirah

The project was developed based on the anticipation that “we will continue to explore space as an inhabitable frontier.” The talks in this session will examine endocrine-based reproduction such as sperm function and biologic fertilization that has occurred in space, noted Dr. Woodruff, who is also professor of molecular biosciences in the Weinberg College of Arts and Sciences and professor of biomedical engineering in the McCormick School of Engineering, both at Northwestern University.

Dr. Woodruff currently has a grant under review by the National Aeronautics and Space Administration that is relevant to the mission of populating space. “If we are going to populate space, which we will need to do based on the length of time we will be there, we are going to have to get gametes into space,” she said. There will be more and more research effort focused on the needs of the humans who are “non-Earth dwelling,” she said.

The next step might be to study embryo development in that environment. Such research would take place at the International Space Station.

“I am interested in endocrine disruptors. What we learn from the study of the challenges to reproduction in space we will be able to apply on earth,” Dr. Woodruff said.

Also on the panel will be Joseph S. Tash, PhD, of Kansas University, Kansas City, whose grant on Space Flight Impacts on Gonadal and Gamete Function already has NASA funding, according to Dr. Woodruff.

Attendees at the upcoming Endocrine Society annual meeting in Chicago can expect many of the scheduled sessions to be practice changing, according to Ann Danoff, MD, clinical chair of this year’s meeting program.

“It’s going to be an absolutely fabulous program. I always encourage clinicians to attend the plenaries to see where the field is going. And we are going big.”

Endocrine Society President Lynnette K. Nieman, MD, will lead off the plenary sessions on March 17, by presenting awards to six visionary investigators. Noteworthy among these will be the work of Diana Lynn Blithe, PhD, National Institutes of Health, for her research on male contraception. Dr. Blithe will speak about what’s in the clinical pipeline and what direction future research will take.

The second plenary session has an intriguing title – Rhythm and Blues. This session will cover circadian rhythmicity, which is, coincidentally, the research area of the three joint winners of the 2017 Nobel Prize in Physiology or Medicine.

In a plenary sessions scheduled for March 17, at 3:00 p.m., the topic under discussion will be the issue of circadian rhythm and metabolic health. Dysregulation of light and dark exposure puts people at risk for a variety of metabolic disease, said Dr. Danoff, who is chief of the medical service at the Philadelphia Veterans Affairs Medical Center. Specifically, two of the presentations – one on Circadian Rhythms, Blue Light, and Setting Your Internal Clock and the other on Improving Health by Time-Restricted Eating – are likely to be enlightening.

The Endocrine Society has revamped this year’s approach to sessions on guidelines to take the format of a discussion of how the guidelines affect patients on case-by-case basis. The moderator of each session will not be a member of the guideline-writing committee, but the panelists will be committee members.

New guidelines to be discussed are those dealing with gender incongruence and testosterone therapy. The session on transgender issues in endocrinology will take place on March 19, and is entitled Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The session on testosterone therapy is entitled: Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline, also on March 19.

Another change to the approach taken to guidelines are sessions that go beyond the guidelines to discuss patients who fall between the cracks. Topics of these sessions are osteoporosis, indeterminate thyroid nodules, and challenging hyperprolactinemia and prolactinoma cases The panels involved in these discussions may include a surgeon, and two-thirds of them will include a fellow. “I am committed to the bringing along of young trainees,” said Dr. Danoff.

And what is an annual meeting without a few debates? On March 18, there will be a debate on Debate: This House Believes that Adrenal Vein Sampling Has a Major Role to Play in the Management of Patients with Primary Aldosteronism. Speaking in favor will be William F. Young Jr., MD, of the Mayo Clinic in Rochester, Minn., and against will be Paul Michael Stewart, MD, of the University of Leeds (England). Another debate topic, scheduled for March 17, will be The LDL Limbo: How Low Should You Go? Taking up the side that Benefits of LDL Reduction Are Continuous and Extend to Extremely Low Levels will be Steven Nissen, MD, of the Cleveland Clinic. There to discuss Lower LDL Is Better but What About Very-Low LDL? will be Henry N. Ginsberg, MD, Columbia University College of Physicians and Surgeons, New York.

Attendees at the upcoming Endocrine Society annual meeting in Chicago can expect many of the scheduled sessions to be practice changing, according to Ann Danoff, MD, clinical chair of this year’s meeting program.

“It’s going to be an absolutely fabulous program. I always encourage clinicians to attend the plenaries to see where the field is going. And we are going big.”

Endocrine Society President Lynnette K. Nieman, MD, will lead off the plenary sessions on March 17, by presenting awards to six visionary investigators. Noteworthy among these will be the work of Diana Lynn Blithe, PhD, National Institutes of Health, for her research on male contraception. Dr. Blithe will speak about what’s in the clinical pipeline and what direction future research will take.

The second plenary session has an intriguing title – Rhythm and Blues. This session will cover circadian rhythmicity, which is, coincidentally, the research area of the three joint winners of the 2017 Nobel Prize in Physiology or Medicine.

In a plenary sessions scheduled for March 17, at 3:00 p.m., the topic under discussion will be the issue of circadian rhythm and metabolic health. Dysregulation of light and dark exposure puts people at risk for a variety of metabolic disease, said Dr. Danoff, who is chief of the medical service at the Philadelphia Veterans Affairs Medical Center. Specifically, two of the presentations – one on Circadian Rhythms, Blue Light, and Setting Your Internal Clock and the other on Improving Health by Time-Restricted Eating – are likely to be enlightening.

The Endocrine Society has revamped this year’s approach to sessions on guidelines to take the format of a discussion of how the guidelines affect patients on case-by-case basis. The moderator of each session will not be a member of the guideline-writing committee, but the panelists will be committee members.

New guidelines to be discussed are those dealing with gender incongruence and testosterone therapy. The session on transgender issues in endocrinology will take place on March 19, and is entitled Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The session on testosterone therapy is entitled: Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline, also on March 19.

Another change to the approach taken to guidelines are sessions that go beyond the guidelines to discuss patients who fall between the cracks. Topics of these sessions are osteoporosis, indeterminate thyroid nodules, and challenging hyperprolactinemia and prolactinoma cases The panels involved in these discussions may include a surgeon, and two-thirds of them will include a fellow. “I am committed to the bringing along of young trainees,” said Dr. Danoff.

And what is an annual meeting without a few debates? On March 18, there will be a debate on Debate: This House Believes that Adrenal Vein Sampling Has a Major Role to Play in the Management of Patients with Primary Aldosteronism. Speaking in favor will be William F. Young Jr., MD, of the Mayo Clinic in Rochester, Minn., and against will be Paul Michael Stewart, MD, of the University of Leeds (England). Another debate topic, scheduled for March 17, will be The LDL Limbo: How Low Should You Go? Taking up the side that Benefits of LDL Reduction Are Continuous and Extend to Extremely Low Levels will be Steven Nissen, MD, of the Cleveland Clinic. There to discuss Lower LDL Is Better but What About Very-Low LDL? will be Henry N. Ginsberg, MD, Columbia University College of Physicians and Surgeons, New York.

Attendees at the upcoming Endocrine Society annual meeting in Chicago can expect many of the scheduled sessions to be practice changing, according to Ann Danoff, MD, clinical chair of this year’s meeting program.

“It’s going to be an absolutely fabulous program. I always encourage clinicians to attend the plenaries to see where the field is going. And we are going big.”

Endocrine Society President Lynnette K. Nieman, MD, will lead off the plenary sessions on March 17, by presenting awards to six visionary investigators. Noteworthy among these will be the work of Diana Lynn Blithe, PhD, National Institutes of Health, for her research on male contraception. Dr. Blithe will speak about what’s in the clinical pipeline and what direction future research will take.

The second plenary session has an intriguing title – Rhythm and Blues. This session will cover circadian rhythmicity, which is, coincidentally, the research area of the three joint winners of the 2017 Nobel Prize in Physiology or Medicine.

In a plenary sessions scheduled for March 17, at 3:00 p.m., the topic under discussion will be the issue of circadian rhythm and metabolic health. Dysregulation of light and dark exposure puts people at risk for a variety of metabolic disease, said Dr. Danoff, who is chief of the medical service at the Philadelphia Veterans Affairs Medical Center. Specifically, two of the presentations – one on Circadian Rhythms, Blue Light, and Setting Your Internal Clock and the other on Improving Health by Time-Restricted Eating – are likely to be enlightening.

The Endocrine Society has revamped this year’s approach to sessions on guidelines to take the format of a discussion of how the guidelines affect patients on case-by-case basis. The moderator of each session will not be a member of the guideline-writing committee, but the panelists will be committee members.

New guidelines to be discussed are those dealing with gender incongruence and testosterone therapy. The session on transgender issues in endocrinology will take place on March 19, and is entitled Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The session on testosterone therapy is entitled: Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline, also on March 19.

Another change to the approach taken to guidelines are sessions that go beyond the guidelines to discuss patients who fall between the cracks. Topics of these sessions are osteoporosis, indeterminate thyroid nodules, and challenging hyperprolactinemia and prolactinoma cases The panels involved in these discussions may include a surgeon, and two-thirds of them will include a fellow. “I am committed to the bringing along of young trainees,” said Dr. Danoff.

And what is an annual meeting without a few debates? On March 18, there will be a debate on Debate: This House Believes that Adrenal Vein Sampling Has a Major Role to Play in the Management of Patients with Primary Aldosteronism. Speaking in favor will be William F. Young Jr., MD, of the Mayo Clinic in Rochester, Minn., and against will be Paul Michael Stewart, MD, of the University of Leeds (England). Another debate topic, scheduled for March 17, will be The LDL Limbo: How Low Should You Go? Taking up the side that Benefits of LDL Reduction Are Continuous and Extend to Extremely Low Levels will be Steven Nissen, MD, of the Cleveland Clinic. There to discuss Lower LDL Is Better but What About Very-Low LDL? will be Henry N. Ginsberg, MD, Columbia University College of Physicians and Surgeons, New York.