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1.   Popular Prostate Cancer Treatment Associated with Bone Decay
2.   Experts Advocate Realigning Type 2 Diabetes Treatments with Disease’s Natural History
3.   New Patient Guide on Congenital Adrenal Hyperplasia from The Hormone Foundation

1. Popular Prostate Cancer Treatment Associated with Bone Decay

“Virtual bone biopsies” may help identify men at risk for fractures

Using novel technology allowing “virtual bone biopsies” researchers have found that a common treatment for prostate cancer called androgen deprivation therapy (ADT) is associated with structural decay of cortical and trabecular bone. The study has been accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM). 

Prostate cancer is the second most common cancer in men worldwide and estimates suggest there are currently 600,000 men in the United States with the condition who are being treated with ADT. Prostate cancer relies upon male hormones for its growth and ADT is a common treatment because it suppresses or blocks the production or action of male sex hormones. This is the first study to examine changes in bone structure during ADT.

“We used a new technology that allows us to assess bone microarchitecture and we found ADT is associated with structural decay of corticol (hard outer shell) and trabecular (spongy inner mesh) bone,” said Emma Hamilton, MBBS and Mathis Grossmann, MD, PhD, of the University of Melbourne in Australia and lead authors of the study. “This technology may be a useful test in predicting fractures in patients, but further research is needed in identifying individuals at greatest fracture risk as well as optimal therapeutic strategies.”

In this study, researchers conducted a 12 month prospective observational study of 26 men with prostate cancer who began ADT. At several points during the study, measurements were taken for sex steroid levels, bone turnover markers and bone mineral density. Furthermore, researchers used three-dimensional high resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture. This technology allows researchers to take virtual bone biopsies, according to Grossmann.

“Sex steroid deficiency induced by ADT for prostate cancer results in microarchitectural decay,” said Grossmann. “Bone fragility in these men may be more closely linked to testosterone than estradiol deficiency.”

Other researchers working on the study include: A. Ghasem-Zadeh, E. Gianatti, D. Lim-Joon, D. Bolton, R. Zebaze, E. Seeman and J.D. Zajac of the University of Melbourne in Australia.

The article, “Structural Decay of Bone Microarchitecture in Men with Prostate Cancer treated with Androgen Deprivation Therapy,” will appear in the December 2010 issue of JCEM.

2.  Experts Advocate Realigning Type 2 Diabetes Treatments with Disease’s Natural History

Endocrine Society launches Web site for primary care physicians on applying new insights into the role of beta-cells in type 2 diabetes to clinical practice

A new consensus statement published in the September, 2010, issue of The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM) finds that the increasing recognition that beta-cell failure occurs much earlier and severely than commonly believed suggests that regular glycemia screening, early identification of patients at metabolic risk and prompt and aggressive intervention deserves greater emphasis.

The consensus statement is based on the findings of a working group of basic researchers, clinical endocrinologists and primary care physicians convened by The Endocrine Society, to consider whether current knowledge regarding pancreatic beta-cell defects justifies retargeting and retiming treatment for diabetes in clinical practice. 

“There is widespread evidence that conventional approaches to the management of type 2 diabetes have been inadequate,” said Jack L. Leahy, MD, of the Vermont Regional Diabetes Center in South Burlington, and one of the authors of the consensus statement. “Studies have increasingly shown that beta-cells have an important role in the progression of diabetes and if we could gain a better understanding of that role, we may be able to develop new and effective means of treatment. To that end, working group members advocate for continued basic research to elucidate the nature and mechanisms of beta-cell failure in type 2 diabetes.”

Evidence from both human and animal studies suggests that type 2 diabetes is characterized by dysfunctional beta-cells that cannot adapt insulin secretion to compensate for increasing insulin resistance. Beta-cell failure is believed to occur at an early stage in the progression of diabetes, and accumulating evidence suggests that the decline in beta-cell function may be slowed or even reversed, particularly if addressed early.

“Another recommendation of the working group is to explore new educational approaches to promote pathophysiology-based clinical practices, and that is why the Society has launched the new Web site, BetaCellsinDiabetes.org,” said Leahy. “It is our hope that the new site will aid primary care physicians in the interpretation of concepts of disease pathogenesis, such as beta-cell dysfunction, and improve medical decision-making regarding treatment of type 2 diabetes. We have made the site practical by synthesizing research, creating case studies, providing a curated list of the published literature, and inviting viewers to comment throughout the site.”

In the consensus statement, experts also recommend additional studies to establish the clinical value of pharmacological therapies targeting beta-cell function. In addition, further research should aim to determine whether specific genetic subtypes of type 2 diabetes lend themselves to individualized therapy to slow or reverse beta-cell decline.

“More research is needed to determine whether preserving beta-cell function improves morbidity and mortality rates,” said Leahy. “Nonetheless, the increasing recognition that beta-cell failure occurs much earlier and severely than commonly believed suggests that regular glycemia screening, early identification of patients at metabolic risk and prompt and aggressive intervention deserves greater emphasis.”

The 2009 working group meeting was funded by an unrestricted educational grant from Novo Nordisk. The consensus statement, “Targeting β-Cell Function Early in the Course of Therapy for Type 2 Diabetes Mellitus,” appears in the September 2010 issue of JCEM.

3. New Patient Guide on Congenital Adrenal Hyperplasia from The Hormone Foundation

The Hormone Foundation recently released a patient guide on congenital adrenal hyperplasia (CAH) as a companion piece to The Endocrine Society’s clinical practice guideline for physicians.  The patient guide describes this genetic disorder that interferes with the adrenal glands' ability to make proper amounts of cortisol, aldosterone and androgens. The most common form of CAH results from having too little cortisol—the so-called stress hormone essential to survival—and too little aldosterone, which regulates water balance and blood pressure, along with too much androgen, a male sex hormone.

CAH can range from mild to severe.  The most severe form can cause life-threatening vomiting, weight loss and dehydration in the first weeks of life. To prevent such a crisis, babies are tested for CAH shortly after birth in most developed countries. Excess androgens can lead to ambiguous genitalia in baby girls—genitals that may look more male than female, even though a girl’s internal reproductive organs are normal.

The patient guide outlines treatment options, which may include life-long daily medication to replace the lacking hormones and, for girls, surgery to correct ambiguous genitalia.  People with severe CAH should carry medical identification warning that they need an immediate injection of life-saving hydrocortisone in the event of an emergency.  Milder forms of CAH may not need any treatment.  Patients and parents are advised to closely following their physician’s instructions.

The patient guide is available at: http://www.hormone.org/Resources/upload/congenital-adrenal-hyperplasia-patient-guide-083110.pdf

 

 

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Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Md. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org.