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American Association of Clinical Endocrinologists, May 1-5, 2013

The American Association of Clinical Endocrinologists' 22nd Annual Scientific and Clinical Congress

The annual meeting of the American Association of Clinical Endocrinologists was held from May 1 to 5 in Phoenix and attracted approximately 17,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in endocrinology. The conference highlighted recent advances in endocrinology, diabetes, and metabolism.

In one study, Robert Levine, M.D., of the Thyroid Center of New Hampshire in Nashua, and colleagues evaluated 200 consecutive patients with thyroid nodules to determine how the nodules were detected and whether the mode of detection impacted the probability of the patient having cancer.

"We found that approximately one-third had been found on physical exam and the cancer rate was 9 percent. In another approximate one-third, the nodules were an incidental finding at another imaging study such as a chest computed tomography scan. In this group, the cancer incidence was much lower at 1.5 percent," said Levine. "The study points out the importance of a good physical exam as a way to detect thyroid cancer. We plan to further investigate other practice settings to see if the results are confirmed."

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In another study, Aaron Vinik, M.D., Ph.D., of the Eastern Virginia Medical School in Norfolk, and colleagues found that a new device, SUDOSCAN, which identifies sweat dysfunction in the hands and feet by measuring the skin conductance response through the sweat glands, is an effective tool for the identification of diabetic neuropathy, showing high sensitivity and specificity as well as good positive and negative predictive values.

"In this study, we have shown that a test, which takes no more than three to five minutes, can be run by an untrained technician. Test interpretation demands no special training and showed that 78 patients with established diabetic neuropathy had reduced electrical skin conductivity compared with 210 healthy controls," said Vinik. "The findings are objective, reproducible, and have a sensitivity of 78 percent and specificity of 85 to 92 percent better than clinical evaluation and standard neurological testing."

The study was funded by Impeto, the manufacturer of the SUDOSCAN.

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In a prospective study of a food delivery notification system on two internal medicine floors, Michael Jakoby, M.D., of the Southern Illinois University School of Medicine in Springfield, and colleagues evaluated the link between delivery of food and administration of mealtime insulin.

"Our study found that only one in three doses of mealtime insulin was administered within the recommended window of plus/minus 15 to 20 minutes of food delivery on an internal medicine floor without a formal tray delivery notification system," said Jakoby. "On the intervention floor, where food service personnel were required to notify the unit secretary of tray delivery, the frequency of on-time insulin dosing increased significantly (50.4 versus 35.5 percent). Median time variance between delivery of food and insulin administration was reduced by slightly more than two-fold."

The investigators also found that glycemic control, measured as a mean of capillary blood glucose measurements recorded before lunch, dinner, and bedtime, was significantly better on the intervention floor than the control floor.

"More closely coordinating mealtime insulin dosing and food delivery improves blood glucose control without increasing the risk of hypoglycemia," added Jakoby. "Results of the study will hopefully motivate physicians who manage diabetes in the hospital to work with their health care systems to implement strategies for linking food delivery and mealtime insulin dosing."

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A case study performed by Richard Pinsker, M.D., and Hineshkumar Upadhyay, M.D., of Jamaica, N.Y., found that one patient who smoked marijuana for over 15 years had a deficiency of testosterone, cortisone, and thyroid hormone due to a lack of pituitary function.

"The patient presented to the emergency room with low blood pressure, weakness, shortness of breath, and gynecomastia. No cause other than chronic marijuana use was found to explain the pituitary dysfunction. The patient rapidly improved with hormone replacement," said Pinsker. "Marijuana is an underestimated and underappreciated potential cause of glandular dysfunction, including hypopituitarism, which could be potentially fatal. Patients often do not give an accurate drug history and physicians sometimes do not ask enough about relevant substance abuse."

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Using electronic medical records, Sameer Ansar, M.D., of Michigan State University in East Lansing, and colleagues collected data for 101 patients with ultrasound-guided fine needle aspiration (FNA) of 174 nodules. After each procedure, the investigators provided an "adequate" or "inadequate" rating based on rapid onsite evaluation (ROSE) without assistance of a cytologist.

"Nearly all (96.6 percent) of 147 specimens interpreted as adequate onsite remained concurrently adequate at time of diagnosis by the cytopathologist, and five (3.4 percent) were changed by the cytopathologist to non-diagnostic. Twenty-nine specimens were interpreted as inadequate onsite, of which three (10.3 percent) were changed to adequate by the cytopathologist," said Ansar. "The final calculation identified 145 specimens as adequate and 29 as inadequate, yielding an overall 96 percent (final versus onsite) level of agreement for specimen adequacy."

Overall, Ansar and colleagues concluded that the results of specimen adequacy for FNA performed solely by an endocrinologist in an office-based setting without assistance of a cytologist were comparable to published data by other physicians performing ROSE but with the assistance of a cytologist.

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