Exploring "Secretion" Hormone Replacement Therapy and Hormone Resistance-2021 Frontier Progress in Endocrine and Metabolic Diseases Summit Forum held in Tianjin

Introduction: In order to promote the development of the subject of endocrine and metabolic diseases, and to convey the new progress and new ideas of endocrine and metabolic diseases, May 21-23, 2021 endocrine and metabolic diseases frontier progress co-sponsored by the Chinese National Health Association and the Chinese Society of Geriatric Healthcare The Summit Forum (CDEF) was successfully held in Tianjin
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 Professor Chen Liming, vice chairman of Diabetes Branch of Chinese Medical Association, president of Zhu Xianyi Memorial Hospital (Metabolic Disease Hospital) of Tianjin Medical University, and executive chairman of the conference, chaired the opening ceremony
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Professor Mu Yiming, the tenth chairman of the Endocrinology Branch of the Chinese Medical Association, attended the opening ceremony and delivered a speech
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 Chairperson of the conference, Professor Mu Yiming of the PLA General Hospital pointed out that the theme of this year's CDEF forum is "hormone replacement therapy and hormone resistance"
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This year’s CDEF Forum invited a number of well-known endocrinologists through a combination of “offline + cloud” to discuss hormone replacement therapy for diabetes, thyroid, adrenal gland, pituitary, and gonadal related diseases, as well as hot issues related to hormone resistance.
And enthusiastic exchanges and discussions
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This conference has a total of 21 theme lectures, 11 special sessions, 3 guide consensus and new drug release conferences, and 3 characteristic dialogues-"Experts Face to Face".
The sections have been carefully designed and each has its own characteristics, emphasizing the in-depth topic And improve participation
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 This conference invited Professor Mu Yiming, Professor Zhu Dalong, Professor Guo Lixin, Professor Chen Li, Professor Shan Zhongyan, Professor Hong Tianpei, Professor Ji Qiuhe, Professor Li Xiaoying, Professor Peng Yongde, Professor Yan Li, Professor Xia Weibo, and Shi Lixin 48 endocrinologists including professors took the stage to give lectures
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Endocrinologists from all over the country are enthusiastic about learning.
More than 500 colleagues attended the conference, more than 3,000 colleagues participated online, and the number of live broadcast viewers exceeded 48,600
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There was a lot of dry goods exchanges before the conference, and many heavy guides/consensus were introduced.
In order to help everyone better understand the guideline consensus, and promote the standard and rational use of drugs by endocrinologists, this forum specially set up a "Guideline Interpretation" link
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On the afternoon of May 21st, Professor Zhang Qiu, Professor Ji Qiuhe, Professor Liu Libin, Professor Su Qing, Professor Wang Guang, Professor Yu Xuefeng, Professor Xiao Xinhua, and Professor Ma Jianhua respectively discussed growth hormone deficiency, type 2 diabetes and non-alcoholic fat Guidelines for drug treatment of liver (NAFLD), pheochromocytoma, undifferentiated thyroid cancer, primary aldosteronism, and diabetes were interpreted, and the content involved 7 sections including DPP-4 inhibitors, GLP-1RA, and clinical application of insulin pumps.
1 domestic and foreign latest guideline for diagnosis and treatment of endocrine diseases
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The topic lectures were wonderful, and the famous experts talked about hormone therapy and resistance.
How to diagnose sexual dysplasia (DSD)? Professor Li Xiaoying from Zhongshan Hospital Affiliated to Fudan University brought valuable experience in diagnosis and treatment to everyone.
He mentioned: “The process of sexual differentiation and development is a very complicated and orderly process.
Patients often suffer from unclear sex of the external genitalia after birth and after puberty.
lack of secondary sexual characteristics, breasts are not developed, primary amenorrhea, short stature and treatment "
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Subsequently, Professor Li Xiaoying made a detailed analysis of 9 cases and shared the diagnosis ideas of DSD
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 Professor Li Xiaoying gave a speech What is the effect of thyroid hormone on brain development, and how to deal with it clinically? Professor Shan Zhongyan from the First Affiliated Hospital of China Medical University told us that T4 plays a key role in brain development.
Maternal T4 can affect offspring’s brain development through the placenta, and the offspring’s intelligence is inverted with maternal blood FT4 levels in early pregnancy.
U" type relationship, too high or too low FT4 may lead to impaired brain development of offspring
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In addition, subclinical hypothyroidism (hypothyroidism) during pregnancy may also affect the brain development of offspring
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Therefore, the prevention of thyroid diseases in women of childbearing age should be moved forward, and screening should be carried out as soon as possible during pregnancy and 8 weeks of gestation, and correct diagnosis and early treatment should be done to achieve TSH and FT4 standards
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 Hormone replacement therapy is still the main treatment method for endocrine dysfunction diseases
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Professor Yan Li from Sun Yat-sen Memorial Hospital of Sun Yat-sen University launched a wonderful academic report with two questions-"Why respond to "extreme"" and "How to respond to "extreme"" as the guide
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Professor Yan mentioned that the only reason for the "excitation" is that the degree of endocrine function decline is different, there are many influencing factors for reasonable substitution, the types of hormones used in different stress conditions and different body conditions are different
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So how to adapt to the "excitement"? The first step is to diagnose, then to evaluate the needs (physiological needs, treatment goals), to formulate an individualized treatment plan, and finally to evaluate the efficacy
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 Obesity is a hot topic right now
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The traditional belief is that obesity in old age will lead to a decline in the quality of life.
Is this really the case? Professor Zhang Lihui from the Second Hospital of Hebei Medical University has seen different results through research and analysis
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Professor Zhang told us that we should be cautious in explaining the correlation between BMI and death risk in elderly patients.
Patients aged ≥65 years have a weak linear or non-linear relationship between BMI and death risk.
Obesity may not be an independent risk factor for increased death risk
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It is a more feasible way of body mass management to correct the behavioral habits that cause obesity instead of obesity itself, such as addiction to tobacco and alcohol, less exercise, high-fat and high-calorie diet
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 Acromegaly, as an endocrine and metabolic disease with insidious onset, is characterized by excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in the circulation
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Professor Li Yanbing from the First Affiliated Hospital of Sun Yat-sen University told us that because circulating IGF-1 has a half-life of about 15 hours and serum levels are relatively stable, IGF-1 is recommended as a screening indicator for acromegaly
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Magnetic resonance imaging (MRI) sellar scan is the first choice for localization diagnosis
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In terms of treatment goals, it is emphasized that the reduction of serum IGF-1 levels to within the normal range matching age and gender as a key indicator is the best indicator of disease control, and is related to improving survival and reducing mortality in patients with acromegaly
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 Professor Li Qifu from the First Affiliated Hospital of Chongqing Medical University told us through 7 cases that adrenal nodules should be seen in the endocrinology department.
The key point of diagnosis is to distinguish benign, malignant and hormone secretion functions
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If the CT plain scan prompts, the diameter is less than 4cm, and the plain scan CT value is less than 10, indicating that the possibility of benignity is higher; if the diameter is greater than 4cm, the plain scan CT value is greater than 20, which indicates the possibility of malignancy is higher
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Hormone secretion function was evaluated by 1 mg dexamethasone inhibition test, MNs, and ARR
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 Professor Shi Yongquan from Shanghai Changzheng Hospital shared his experience in the treatment of glucocorticoid resistance and refractory hyperthyroidism exophthalmos
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Professor Shi told us that the causes of refractory hyperthyroidism exophthalmia include: response to hormones, but the effect is not significant; glucocorticoid resistance; glucocorticoid intolerance
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At the same time, it is emphasized that glucocorticoids are mainly used for patients with moderate or severe thyroid-related ophthalmopathy in the active stage.
For mild exophthalmos and inactive exophthalmos, it does not need to be used or has little effect
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 Professor Zhong Liyong from Beijing Tiantan Hospital, Capital Medical University, shared the clinical features and diagnosis and treatment experience of two special types of rare functional pituitary adenomas, namely functional gonadotropin (FGnA) tumors and thyroid-stimulating hormone (TSH) tumors
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Professor Zhong analyzed the clinical characteristics, sex hormone characteristics, influencing and histological characteristics, differential diagnosis, treatment response differences of different populations, including women of childbearing age, men, and children with FGnA tumors; clinical endocrine characteristics and diagnostic criteria, diagnosis and treatment pathways of TSH tumors , So that everyone has a comprehensive understanding and understanding of these two types of rare diseases
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 The chairperson of the conference, Professor Mu Yiming of the PLA General Hospital first introduced the overall etiology classification and mechanism of diabetes insipidus, as well as the qualitative and differential diagnosis, and then made a detailed analysis of the nephrogenic diabetes insipidus (NDI) and brought it New strategies for NDI treatment: rescue the plasma membrane expression of NDI AVP2R (V2R) by cell permeability antagonists; activate mutant and misfolded V2R by cell permeation agonists; rescue mutant V2R plasma membrane expression and signals by cell permeation agonists Conduction; a mechanism that bypasses the V2R signal and allows AQP2 to translocate to the plasma membrane
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 Professor Xia Weibo from Peking Union Medical College Hospital of Chinese Academy of Medical Sciences discussed with us the issue of "hypoparathyroidism (HP) blood calcium standard"
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The existing treatment methods are: acute phase: rapid correction of hypocalcemia, high blood phosphorus and hypomagnesium; chronic phase: standard treatment: oral calcium + active vitamin D/analogs
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HP is currently the only endocrine hormone deficiency disease for which hormone replacement therapy has not been given.
This is because the half-life of existing PTH analogues is relatively short (~3 hours), and compared with standard treatment, it cannot significantly reduce hypocalcemia, The incidence of hypercalcemia or hypercalciuria (CHMP 2017)
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Currently, TransCon PTH's key global Phase II study has reached the primary clinical endpoint
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TransCon technology can effectively protect PTH from receptor-mediated binding and renal clearance.
TransCon PTH continuously releases PTH and can maintain the PTH concentration within the normal physiological range
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 Professor Xia Weibo made a speech.
Professor Liu Jianying from the First Affiliated Hospital of Nanchang University gave us a detailed introduction to the diagnosis and treatment of pituitary thyroid-stimulating hormone (TSH) adenomas from clinical manifestations, laboratory examinations, differential diagnosis, and treatment methods
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Pituitary TSH adenoma is a type of functional pituitary adenoma, which is the main cause of central hyperthyroidism.
Serum free thyroid hormone (FT4, FT3) levels are increased, and serum TSH levels are not inhibited and accompanied by varying degrees The manifestations of thyrotoxicosis and goiter are clinical features
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Regardless of surgery, radiotherapy or drug treatment, close follow-up is required
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Long-term follow-up is required 3, 6 months and 1 year after surgery and every year thereafter
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 Low-risk differentiated thyroid cancer (DTC) is controversial in all aspects of optimal management, including the choice of surgery, radioactive iodine (RAI) ablation treatment of residual thyroid, thyroid hormone supplementation, and long-term follow-up
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These controversies lead to large differences in patient care and may face injuries caused by overtreatment or undertreatment
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Professor Shi Lixin from the Affiliated Hospital of Guizhou Medical University combined the 2015 ATA guidelines on the optimal scope of surgical resection for low-risk DTC, whether to implement preventive central lymph node dissection (pCLND) in patients with low-risk DTC, and whether to select residual thyroid radioactive iodine (RAI) ) Pretreatment with recombinant human thyroid-stimulating hormone (rhTSH) before dose, recommended dose of RRAI residual ablation treatment, optimal TSH suppression target, long-term follow-up monitoring and other controversial issues, expressed his own opinions
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 Professor Chen Li from Qilu Hospital of Shandong University shared the difficulties and thoughts on hormone replacement therapy for hypophysis
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For patients, attention should be paid to the assessment of pituitary function both before and after surgery.
For patients with hypophyseal function, hormone replacement therapy should be carried out in a timely, timely, reasonable and dynamic manner.
At the same time, strengthening follow-up and patient education will help rational treatment.
Avoid crisis
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In addition, the principle of hormone replacement therapy is to simulate the physiological state as much as possible, what is missing, what is missing, how much is missing, the minimum effective dose, and individualization
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 Professor Chen Li made a speech.
Big coffee gathered in the right way to control sugar-actively promote the concept of full-process diabetes management and comprehensive prevention and control.
Professor Guo Lixin from Beijing Hospital introduced the updated points of the "Guidelines for Diagnosis and Treatment of Diabetes in the Elderly in China (2021 Edition)"
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The core of this version of the guideline is to emphasize that elderly diabetic patients should be "individualized" management, and put forward a blood glucose management path suitable for elderly diabetic patients, a simple treatment concept and a "de-enhanced" treatment strategy
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 What are the new developments in the research of hypoglycemic drugs? Professor Hong Tianpei of Peking University Third Hospital analyzed a series of basic studies and found that glucagon receptor (GCGR) monoclonal antibody can promote the transformation of pancreatic islets from type 1 diabetes and type 2 diabetes from α to β cells and the regeneration of β cells.
The principle is to competitively block the binding of glucagon and GCGR
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Professor Peng Yongde from the First People's Hospital of Shanghai Jiaotong University analyzes different intestinal types, individualized nutrition and drug interventions, and may provide a new and personalized method of intestinal ecology for the management of type 2 diabetes in the future
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 Professor Ran Xingwu from West China Hospital of Sichuan University shared early screening and intervention strategies for diabetic lower extremity vascular disease.
He pointed out that if diabetic patients have one or more of the risk factors of smoking, women, hypertension, age over 40, etc.
, It is recommended to perform PAD screening; in order to reduce the mortality of diabetic patients, vascular color Doppler ultrasound should be used to screen the proximal arteries of diabetic patients
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In addition, interventions for traditional cardiovascular risk factors and vascular expansion interventions for patients with PAD to improve blood supply are necessary to reduce mortality and the risk of amputation
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 Experts face-to-face-explore the "secretion" and talk about endocrine disputes and conflicts 1.
Thyroid section Professor Shan Zhongyan brought 2 thyroid cases from the Endocrinology Department of the First Affiliated Hospital of China Medical University, and made recommendations, diagnosis, and diagnosis for the next step.
Step by step, I asked Ji Qiuhe, Yu Xuefeng, Kuang Hongyu, and Yang Jing questions about treatment suggestions
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Five experts stripped their cocoons, followed the temptation, and engaged in heated discussions around the theme of "Tyroid Consultation-"Butterfly and Butterfly" endlessly", firmly grasping the ears of online and offline participants
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   2.
In the adrenal section, five big names such as Yiming, Wang Guixia, Qin Guijun, Zhang Lihui, Xi Guangxia, combined with clinical cases, discussed "diagnosis of adrenal hypofunction", "choice of glucocorticoids" and "perioperative glucocorticoids" A lively discussion of key clinical concerns such as "substitution therapy" gave us a vivid clinical practice class on the diagnosis and treatment of adrenal insufficiency
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 3.
In other sections, five professors: Qu Shen, Sun Zilin, Li Yan, Xu Xiangjin, and Ran Xingwu talked about "what are the best methods and best diagnostic criteria for evaluating obesity" and "what life>
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 In addition, the "Expert Consensus on the Management of Type 2 Diabetes and Non-alcoholic Fatty Liver Disease in Adults in China" and "Healthy China-Diabetes Heart and Kidney Protection Action Expansion Plan, and China Diabetes Complicated (Concomitant) Prevalence and Risk Factors Survey Project" The launch and project launch ceremonies were carried out in this forum respectively
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 At the closing ceremony, Professor Chen Liming, the executive chairman of the conference, concluded: "This two-day forum is full of work and work.
I believe it can be inspiring for everyone's clinical practice and will be a real help to improve clinical practice
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Finally, the chairperson of the conference, Mu Yi Professor Ming expressed his gratitude to all experts, participating doctors, companies, and staff for their hard work
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"So far, the 2021 Frontier Advances in Endocrine and Metabolic Diseases Summit Forum has come to a successful conclusion!