Szu-Tah ChenDr. Taiwan

Szu-Tah ChenDr.
Dr. Szu-Tah Chen is an accomplished endocrinologist specializing in thyroidology, diabetes, and endocrine metabolism. He earned his Bachelor of Medicine from Kaohsiung Medical College and completed postgraduate studies at Chang Gung University of Science and Technology. Dr. Chen underwent residency training in Internal Medicine and fellowship training in Endocrinology and Metabolism at Chang Gung Memorial Hospital (CGMH), Linkou, where he has served since 1990. Over the past three decades, Dr. Chen has made significant contributions to endocrine medicine through clinical service, academic teaching, and research. He was Chief of the Division of Endocrinology and Metabolism at CGMH, Linkou (2014–2020), and led the hospital’s Diabetes Center (2014–2022). Since 2022, he has served as a consultant attending physician at New Taipei Municipal Tucheng Hospital, operated by the Chang Gung Medical Foundation. Concurrently, he holds an academic appointment as Assistant Professor of Medicine at Chang Gung University. Dr. Chen is board-certified in Internal Medicine and in Endocrinology & Metabolism by the Taiwan Society of Internal Medicine and the Endocrine Society of Taiwan. He is an active leader in several professional organizations, including serving as Director of the Endocrinology Society, Pituitary Society, and Taiwan Society of Aldosteronism, as well as Deputy Director of the Taiwan Society of Ultrasound in Medicine. His research focuses on thyroid cancer, diabetes mellitus, and other endocrine disorders. Dr. Chen has published over forty peer-reviewed papers in leading journals such as Clinical and Experimental Metastasis, Scientific Reports, Frontiers in Endocrinology, and the Journal of the Formosan Medical Association. His work has advanced the understanding of endocrine diseases and improved diagnostic and therapeutic strategies for patients in Taiwan and beyond.

21 MARCH

Time Session
13:30
15:00
[Symposium] Pituitary (1)
Consensus in Pituitary Pathology
Hong-Da LinTaiwan Moderator
Roderick Clifton-BlighAustralia Moderator
  • Consensus in Pituitary Pathology: Impact after New Classification for Japan
    Naoko InoshitaJapan Speaker Consensus in Pituitary Pathology: Impact after New Classification for JapanIn Japan, the brain tumor handling rules are essentially based on the WHO classification. However, the introduction of the term pituitary neuroendocrine tumour (PitNET) has occasionally led to misunderstanding in clinical practice, particularly regarding the implication of malignancy. In this lecture, I will present a consensus-oriented approach in pituitary pathology, focusing on practical strategies developed through multidisciplinary collaboration for the benefit of clinicians and patients. First, I will show how the addition of touch smear cytology to frozen section diagnosis during surgery can improve the accuracy of margin assessment and increase the likelihood of achieving the intended surgical goal, including adequate removal of hormone-producing tumours. Second, I will emphasize that truly malignant PitNETs are extremely rare, and that the term “NET” should not be equated with malignancy. Third, I will discuss the well-known discrepancy between hormone immunohistochemistry and clinical functionality, highlighting the importance of careful pathological interpretation. These perspectives reflect our pathology team’s commitment to accurate communication and clinically relevant pathological diagnosis.
  • The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?
    Szu-Tah ChenTaiwan Speaker The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?The 2022 World Health Organization (WHO) Classification of Endocrine and Neuroendocrine Tumors redefined pituitary adenomas as pituitary neuroendocrine tumors (PitNETs) within the International Classification of Diseases for Oncology, 3rd Edition (ICD-O/3). This change reflects updated insights into tumor biology, recognizing a spectrum of clinical behaviors beyond the traditionally benign designation. A narrative review of the WHO 2022 classification updates was conducted, focusing on their clinical, diagnostic, and epidemiologic implications for practitioners in endocrinology, neurosurgery, and oncology. The reclassification emphasizes the potential for variability in tumor aggressiveness, recurrence, and invasiveness. Clinically, this shift necessitates more careful risk stratification, closer follow-up in selected cases, and a reassessment of treatment algorithms. From a reporting perspective, ICD-O/3 alignment may affect cancer registry data and epidemiologic tracking, altering disease burden estimates. Importantly, the new terminology presents challenges in patient communication, as the label “neuroendocrine tumor” may cause undue anxiety despite the indolent nature of most PitNETs. The WHO 2022 reclassification of pituitary adenomas as PitNETs represents a significant change for clinical practice. While it enhances awareness of potential aggressive behavior, it also requires balanced application in patient care to avoid overtreatment and misperceptions. Practitioners must adapt by refining diagnostic vigilance, tailoring follow-up strategies, and delivering clear patient-centered communication.
  • Consensus in Pituitary Pathology: Impact after New Classification for Korea
    Jae Sung ParkSouth Korea Speaker Consensus in Pituitary Pathology: Impact after New Classification for KoreaThe management of pituitary neuroendocrine tumors (PitNETs) in South Korea is undergoing a significant transition following the 2022 WHO classification. While the shift from "adenoma" to "PitNET" implies a malignant potential, from a neurosurgical perspective, these tumors remain generally far more indolent than primary brain cancers such as high-grade gliomas. Identifying the specific subset of patients who require aggressive intervention is therefore paramount. Our recent institutional study indicates that high-risk non-functioning pituitary adenomas (NFPAs) are more prevalent in younger female patients and exhibit a higher incidence of cavernous sinus invasion. Consequently, a more proactive surgical approach is often warranted for these high-risk phenotypes. Beyond clinical considerations, the Korean healthcare system—characterized by government-led cost controls and supplemental private insurance—faces unique challenges. There is a growing trend of patients requesting malignancy-level ICD coding to secure broader insurance coverage, a phenomenon increasingly driven by external socio-economic factors. Although the Korean Brain Tumor Society (KBTS) previously debated this classification, a definitive consensus remains elusive. Rather than proposing a singular solution, this session aims to raise these multi-faceted issues from a neurosurgical viewpoint, inviting diverse expert perspectives to foster a collective dialogue on the nature of PitNETs within our evolving medical and socio-economic landscape.
201AF

22 MARCH

Time Session
14:00
15:30
[Symposium] Pituitary (3)
Acromegaly
Naoko InoshitaJapan Moderator Consensus in Pituitary Pathology: Impact after New Classification for JapanIn Japan, the brain tumor handling rules are essentially based on the WHO classification. However, the introduction of the term pituitary neuroendocrine tumour (PitNET) has occasionally led to misunderstanding in clinical practice, particularly regarding the implication of malignancy. In this lecture, I will present a consensus-oriented approach in pituitary pathology, focusing on practical strategies developed through multidisciplinary collaboration for the benefit of clinicians and patients. First, I will show how the addition of touch smear cytology to frozen section diagnosis during surgery can improve the accuracy of margin assessment and increase the likelihood of achieving the intended surgical goal, including adequate removal of hormone-producing tumours. Second, I will emphasize that truly malignant PitNETs are extremely rare, and that the term “NET” should not be equated with malignancy. Third, I will discuss the well-known discrepancy between hormone immunohistochemistry and clinical functionality, highlighting the importance of careful pathological interpretation. These perspectives reflect our pathology team’s commitment to accurate communication and clinically relevant pathological diagnosis.
Szu-Tah ChenTaiwan Moderator The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?The 2022 World Health Organization (WHO) Classification of Endocrine and Neuroendocrine Tumors redefined pituitary adenomas as pituitary neuroendocrine tumors (PitNETs) within the International Classification of Diseases for Oncology, 3rd Edition (ICD-O/3). This change reflects updated insights into tumor biology, recognizing a spectrum of clinical behaviors beyond the traditionally benign designation. A narrative review of the WHO 2022 classification updates was conducted, focusing on their clinical, diagnostic, and epidemiologic implications for practitioners in endocrinology, neurosurgery, and oncology. The reclassification emphasizes the potential for variability in tumor aggressiveness, recurrence, and invasiveness. Clinically, this shift necessitates more careful risk stratification, closer follow-up in selected cases, and a reassessment of treatment algorithms. From a reporting perspective, ICD-O/3 alignment may affect cancer registry data and epidemiologic tracking, altering disease burden estimates. Importantly, the new terminology presents challenges in patient communication, as the label “neuroendocrine tumor” may cause undue anxiety despite the indolent nature of most PitNETs. The WHO 2022 reclassification of pituitary adenomas as PitNETs represents a significant change for clinical practice. While it enhances awareness of potential aggressive behavior, it also requires balanced application in patient care to avoid overtreatment and misperceptions. Practitioners must adapt by refining diagnostic vigilance, tailoring follow-up strategies, and delivering clear patient-centered communication.
  • Acromegaly and Cardiovascular Disease: The Research in Taipei Veterans General Hospital
    Harn-Shen ChenTaiwan Speaker Acromegaly and Cardiovascular Disease: The Research in Taipei Veterans General HospitalAcromegaly, characterized by chronic excess growth hormone (GH) and elevated insulin-like growth factor-1 (IGF-1), is associated with increased morbidity and premature mortality, particularly from cardiovascular (CV) complications. Research from Taipei Veterans General Hospital (Taipei VGH) over the past decade has systematically examined how biochemical control, metabolic status, and cardiac function influence patient outcomes, forming a comprehensive institutional understanding of acromegaly-related CV risk. Early studies established the prognostic importance of postoperative hormonal normalization following trans-sphenoidal adenomectomy (TSA). Patients achieving stringent biochemical remission demonstrated markedly reduced long-term mortality, whereas persistent GH/IGF-1 elevation remained a strong predictor of premature death. Even partial hormonal improvement provided measurable survival benefit, highlighting the need for aggressive management and close monitoring after surgery. Subsequent work addressed the metabolic impact of medical therapy, particularly long-acting octreotide. While effective in reducing GH/IGF-1 levels, somatostatin analogs impaired insulin secretion and frequently worsened glucose tolerance. These findings underscore the need to balance biochemical control with careful metabolic surveillance, especially in patients with preexisting glucose abnormalities. In 2020, a nationwide epidemiological study expanded the perspective by detailing incidence, comorbidities, re-operation rates, cancer risk, and mortality trends across Taiwan. Despite modern advances, patients with acromegaly continued to exhibit elevated mortality—predominantly from CV and malignant causes—reinforcing the significance of early diagnosis and rigorous long-term management. Complementing epidemiologic insights, a focused clinical study demonstrated that successful surgical remission led to significant improvements in traditional CV risk factors, including reductions in HbA1c, LDL cholesterol, total cholesterol, and blood pressure one year after TSA. These benefits were most pronounced in patients with normalized IGF-1. The most recent study linked degrees of biochemical control to cardiac structure and function. Patients with uncontrolled or partially controlled acromegaly exhibited increased left ventricular mass and impaired diastolic function, indicating early acromegalic cardiomyopathy even when systolic function remained preserved. Collectively, the Taipei VGH research program highlights that full biochemical remission is essential not only for reducing mortality but also for reversing metabolic abnormalities and preventing progressive cardiac dysfunction.
  • Medication Management for Acromegaly
    Cheol Ryong KuSouth Korea Speaker Medication Management for AcromegalyPharmacological management of acromegaly plays a central role in patients with persistent disease following surgery; however, treatment strategies vary substantially across countries due to differences in healthcare systems and reimbursement policies. Understanding real-world approaches within specific national frameworks provides valuable insight into optimizing long-term disease control. This lecture aims to present the Korean reimbursement-based treatment algorithm for acromegaly and share institutional clinical outcomes using contemporary medical therapies, including pasireotide, pegvisomant, and lanreotide autogel with extended dosing interval (EDI) strategies. In addition, emerging therapeutic candidates under development at our institution will be briefly introduced.
  • Acromegaly: GH Response Pattern to Oral Glucose Load and Personalized Medicine
    Michio OtsukiJapan Speaker Acromegaly: GH Response Pattern to Oral Glucose Load and Personalized MedicineAcromegaly is characterized by elevated levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1), with resultant signs and symptoms of hypersomatotropism. To examine autonomous secretion of GH, an oral glucose tolerance test (OGTT) is used. In most healthy individuals, GH levels decrease to a nadir below 0.4 mg/L after OGTT. In contrast, patients with acromegaly fail to suppress serum GH levels after OGTT. Interestingly, a paradoxical GH response to oral glucose (OG) load is found in one third of acromegalic patients. The mechanism of this paradoxical response in acromegaly is mediated by glucose-dependent insulinotropic polypeptide, which is released after OG administration We found that the paradoxical GH response to OG load reflected the clinical characteristics. The patients the paradoxical GH response to OG load (OG responders) had substantially greater IGF-1 SD scores than nonresponders. Regarding glucose metabolism, 120-minute plasma glucose and immunoreactive insulin after OG administration and hemoglobin A1c were significantly greater in OG responders than in nonresponders. GH levels during octreotide or bromocriptine testing were decreased more significantly in OG responders than in nonresponder. The proportion of pituitary tumors with hypointensity on T2-weighted MRI was significantly greater in OG responders than in nonresponders. OGTT is essential to evaluate autonomous secretion of GH. The paradoxical GH response to OG load is the useful for evaluation of the clinical characteristics of acromegaly and leads to the personalized medicine of acromegaly.
201DE