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08:30
11:30
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Jung Hwan BaekSouth Korea
Speaker
Standard and Advanced Techniques for Thyroid RFAThermal ablation, especially radiofrequency ablation (RFA), is promising technique not only for benign thyroid nodules but also for thyroid cancers. In various thyroid tumors, RFA effectively improves tumor-related symptoms and cosmetic problems by reducing tumor volume. RFA is recently adopted to recurrent and primary thyroid cancers. In terms of complication, major complication rate was reported as 1.4% - 8% according to the types, locations and size of the thyroid tumors.
Therefore, proper techniques and experience of operators are key factors to achieve effective and safe RFA. To maximize efficacy and to minimize complications, the Korean Society of Thyroid Radiology Guidelines (KSThR Guidelines 2012, 2017, and 2025) recommend the use of standard techniques; the perithyroidal lidocaine injection to control pain, trans-isthmic approach, moving-shot technique and hydrodissection (HD) technique. Furthermore, KSThR Guidelines recommend advanced techniques, such as vascular ablation, bolus injection of cold water (to manage nerve damage problems) or tracheal stent assisted RFA.
In this lecture, therefore I will introduce various standard and advanced techniques to maximize the ablation zone and to minimize injury of surrounding critical structures. Furthermore, I will briefly touch “how to combine proper device and techniques” for thyroid RFA.The Efficacy and Safety of RFA for PTMC in Long-Term Cohort Study: Do Above and BeyondThe incidence of thyroid cancer has increased not only in Korea, but in worldwide. This situation is mainly due to an increase in the over detection of small papillary thyroid carcinomas (PTCs) using high-resolution ultrasonography (US). Almost all newly detected thyroid cancers are small papillary thyroid cancers (PTCs), while the incidence of large PTCs and aggressive histological types has remained stable. In addition, mortality of thyroid cancer has remained stable in Korea. Therefore, several studies have suggested over-diagnosis of small thyroid cancers, especially papillary thyroid microcarcinomas (PTMC). Since the majority of PTMCs progress slowly and show excellent outcome and considering the drawbacks of surgery including voice change or hypoparathyroidism, it is time to re-evaluate the role of surgery (especially immediate surgery) for all biopsy proven PTMCs.
According to publications from South Korea and other countries, the incidence of thyroid carcinoma had increased 15-fold between 1993 and 2011; however, its mortality rate did not decrease. Moreover, the number of patients who suffered from surgical complications increased significantly. Considering the exceedingly low disease-specific mortality rate of PTMCs and the potential complications of thyroidectomy, it is imperative to consider alternative management strategies for PTMC management. Therefore, this lecture will review the current oncologic outcome (in both short and long-term follow-up studies) of thermal ablation in PTMC and compare it with the results of active surveillance and surgery.
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Hendra ZufryIndonesia
Speaker
The Efficacy and Safety of Thyroid RFA: The Latest UpdatesRadiofrequency ablation (RFA) of the thyroid has emerged as a minimally invasive alternative to surgery for benign cystic and solid nodules, low risk papillary thyroid microcarcinoma (PTMC), and recurrent thyroid cancer. Standardized training and international guidelines have facilitated its global adoption. Long term efficacy and safety data position thyroid RFA as a primary treatment compared with other thermal techniques.
In recurrent thyroid cysts, RFA achieves a mean volume reduction ratio (VRR) of 87 ± 11.6 % after one session, outperforming ethanol ablation. For benign solid nodules, a single treatment yields 98.8 % VRR at ten year follow up. Larger nodules (> 20 mL) or multinodular goiters often require multiple sessions to optimize shrinkage, cosmesis, and symptom relief.
Autonomous thyroid nodules (ATNs) under 30 mL demonstrate rapid VRR and early TSH normalization, while larger ATNs reach approximately 70 % VRR by six months, correlating with euthyroidism. In indeterminate Bethesda III nodules with low suspicion ultrasound features, RFA delivers 87.4 % VRR at one year in surgery averse patients; Bethesda IV lesions achieve 94.9 ± 6.1 % VRR.
In low risk PTMC, RFA produces 100 % VRR without disrupting thyroid function over two years, offering an alternative to active surveillance. Early stage papillary thyroid cancers (T1a/T1b) show 99.31 % VRR at 48 months, with higher disappearance rates in T1a. In recurrent papillary carcinoma, RFA attains 100 % VRR and comparable disease free survival to reoperation, with fewer complications. A case of recurrent cervical medullary carcinoma reported 68.6 % VRR at six months.
Complication rates are low. Pre procedural risks include lidocaine toxicity; intra procedural events comprise pain, hematoma, burns, and transient voice changes; post procedural issues may involve mild thyroid dysfunction, discomfort, or rare nodule rupture. These events are generally mild and non–life threatening. Optimal outcomes depend on meticulous patient preparation, advanced electrode design, precise anatomic knowledge, judicious anesthesia, and high operator proficiency in basic and advanced RFA techniques. Patient satisfaction scores are consistently high, reflecting improved quality of life and favorable aesthetic outcomes.
Key Word : Thyroid RFA, Efficacy, Safety Profile, Long term Data.
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201DE
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10:30
12:00
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Oral Presentation 1: Thyroid Excellence: From Autoimmunity to Neoplasia
Young Joo ParkSouth Korea
Moderator
Translating the Genetic Landscape of Thyroid Cancer to Precision Diagnosis and TherapyThyroid cancer is characterized by a relatively low mutational burden compared with other solid tumors, with recurrent alterations mainly involving BRAF, RAS, and various fusion genes. Several novel driver candidates have also been identified through next-generation sequencing studies. The frequency and pattern of these genomic alterations differ across thyroid cancer subtypes and are often associated with distinct histopathological phenotypes, providing valuable clues for differential diagnosis. Moreover, molecular subtypes defined by driver mutations are closely linked to tumor biology and clinical behavior, allowing more accurate prediction of disease aggressiveness and prognosis.
Most differentiated thyroid cancers (DTCs) harbor a single dominant driver alteration; however, acquisition of additional mutations such as TERT promoter, tumor suppressor genes, or PI3K–AKT pathway alterations may lead to dedifferentiation and progression to aggressive or metastatic disease. Advances in our understanding of these genetic alterations have refined the pathological classification of thyroid cancer and enabled improved prognostication, treatment selection, and follow-up strategies.
Importantly, the identification of actionable genetic alterations—including RET and NTRK fusions, as well as BRAF mutations—has revolutionized therapeutic approaches. Targeted agents such as selpercatinib, pralsetinib, larotrectinib, and entrectinib demonstrate substantial clinical efficacy with fewer adverse events than multikinase inhibitors, while dabrafenib plus trametinib has shown marked benefit in anaplastic thyroid cancer. With multiple targetable mutations being uncovered, incorporating comprehensive genomic testing into the diagnostic workflow is essential to guide precision therapy for patients with thyroid cancer.
103
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Future Management in Diabetes Mellitus
Vivien LimSingapore
Moderator
The Danger of Obesity in South East Asia and Practical Tips in the Clinic Obesity is steadily increasing in South East Asia (SEA) and with it comes complications naturally follow from it - metabolic, physical and mental. The talk will touch on the following:
- the prevalence of this and the changes over time
- the rising burden of it
- practical tips that can aid in the clinic including busting myths and misconceptions that hamper its management
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Daisuke YabeJapan
Speaker
Advancing toward a Cure for Diabetes: Insights from iPSC-Derived Islet Cell Transplantation TrialType 1 diabetes is characterized by absolute insulin deficiency and marked glycemic variability, creating a constant challenge for individuals who must maintain strict glycemic control to prevent complications and severe hypoglycemia. To address these persistent unmet medical needs, transplantation of pancreatic islet–like cells derived from embryonic stem (ES) or induced pluripotent stem (iPSC) cells has emerged as a promising therapeutic strategy. Encouraging advances have recently been reported from the United States and China. Notably, a world-first autologous transplantation of patient-specific iPSC-derived islet-like cells in China achieved insulin independence with near-normal glycemic control. Despite its promise, concerns remain regarding long-term safety, durability, and broad applicability, underscoring the need for further rigorous clinical evaluation. This lecture will provide an overview of current progress and ongoing challenges in β-cell replacement therapy aimed at curing type 1 diabetes. In addition, I will introduce the study design of our clinical trial at Kyoto University Hospital evaluating allogeneic transplantation of iPSC-derived islet cell sheets (OZTx-410). Through these insights, we aim to highlight both the steady steps already taken and the horizon of possibilities ahead in the pursuit of a functional cure for diabetes.Incretin-Based Therapeutics: Bridging Theory and Practice, and Exploring New HorizonsThe landscape of type 2 diabetes management has been transformed by the advent of incretin-based therapies, including dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. In Japan—where more than 70% of individuals with diabetes are aged 65 years or older and commonly present with a non-obese phenotype and reduced insulin secretory capacity—DPP-4 inhibitors continue to serve as a fundamental treatment option, offering effective glycemic control with minimal risk of hypoglycemia. In contrast, among younger adults with obesity, GLP-1 receptor agonists have emerged as essential agents that not only improve glycemic control but also promote weight reduction and confer cardiovascular and renal benefits. A major advance in 2023 was the approval of tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist that engages both receptors. Tirzepatide has demonstrated robust glucose-lowering and weight-reducing effects in both clinical trials and real-world practice in Japan, further expanding therapeutic opportunities across the region. However, incretin-based therapies are not without challenges: gastrointestinal adverse events remain common, and potential associations with pancreatic and biliary diseases continue to require caution. In older adults, concerns regarding their impact on frailty and sarcopenia demand careful clinical judgment. Furthermore, inappropriate discontinuation of insulin therapy after initiating incretin treatment has occasionally resulted in severe clinical consequences, highlighting the critical need for decision-making that extends beyond the evidence from controlled trials. In response to these issues, the Japan Diabetes Society (JDS) Committee for the Safe Use of Medications released the Recommendations for the Safe Use of Incretin-Related Agents, Second Edition in 2024. Disseminating these recommendations across East Asia and the broader Asia–Oceania region will be essential to ensure the safe and effective application of incretin-based therapies in diverse clinical settings. In this plenary lecture, I will explore strategies to optimize type 2 diabetes management in Asia by harnessing the therapeutic potential of incretin-based agents while proactively mitigating associated risks. Together, we aim to build a future in which innovation, safety, and patient-centered care advance hand in hand.
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Kang-Chih FanTaiwan
Speaker
AI-Driven Precision Drug Therapy: Tailoring Personalized Treatment for Type 2 Diabetes Type 2 diabetes (T2D) is a highly heterogeneous syndrome where "one-size-fits-all" algorithms often fail to address individual pathophysiological variations. While recent guidelines prioritize cardiorenal protection, the choice between second-line agents—particularly SGLT2 inhibitors versus GLP-1 receptor agonists—remains largely empirical. This "trial-and-error" paradigm frequently results in therapeutic inertia and suboptimal glycemic durability.
Artificial Intelligence (AI) and machine learning (ML) offer a paradigm shift from population-based guidelines to precision diabetology. By integrating high-dimensional data from electronic health records (EHR), continuous glucose monitoring (CGM), and omics profiles, AI models can now quantify heterogeneous treatment effects (HTE) at the individual level.
In this presentation, I will discuss:
1. Phenotypic Stratification: Moving beyond classic classification to identify data-driven clusters (e.g., severe insulin-resistant vs. age-related clusters) that dictate distinct disease trajectories.
2. Predictive Pharmacotherapy: Reviewing recent evidence where ML algorithms predict individual glycemic response and weight loss outcomes for specific drug classes. We will highlight how AI-driven decision support can optimize the selection between SGLT2 inhibitors and GLP-1 receptor agonists, maximizing efficacy while minimizing adverse events.
3. Real-World Implementation: Discussing the potential of leveraging large-scale longitudinal datasets, such as Taiwan’s National Health Insurance Research Database, to build robust, population-specific prediction models.
Bridging the gap between data science and clinical practice, this session aims to demonstrate how AI can empower clinicians to prescribe the right drug for the right patient at the right time, fundamentally transforming T2D management.Anti-Obesity Medications: Clinical Use Obesity is a chronic, relapsing neurobehavioral disease requiring long-term management. Recent guidelines have shifted the treatment goal from BMI-centric weight loss to a "health-centered" approach, focusing on the remission of weight-related complications. With the advent of nutrient-stimulated hormone-based therapies, we have entered an era where pharmacotherapy can achieve double-digit weight loss comparable to bariatric surgery, offering systemic organ protection.
In this session, we will navigate the clinical use of anti-obesity medications (AOMs) through three key dimensions based on the latest evidence:
1. Efficacy and Organ Protection: We will review the landmark trials establishing GLP-1 and dual GIP/GLP-1 receptor agonists as the cornerstone of treatment. Highlights include Semaglutide (STEP, SELECT, ESSENCE) and Tirzepatide (SURMOUNT, SUMMIT, SURMOUNT-OSA), demonstrating not only 15–20% weight loss but also breakthrough benefits in cardiovascular outcomes (MACE), heart failure with preserved ejection fraction (HFpEF), metabolic dysfunction-associated steatohepatitis (MASH), and obstructive sleep apnea (OSA).
2. Comorbidity-Directed Strategy: A practical framework for drug selection will be proposed, distinguishing between "Fat Mass Disease" (e.g., OSA, osteoarthritis), which benefits primarily from mechanical weight reduction, and "Sick Fat Disease" (e.g., T2D, CVD, MASH), which requires correction of adipose dysfunction. We will discuss how to prioritize agents like Semaglutide and Tirzepatide for high-risk profiles, while utilizing Naltrexone/Bupropion for emotional eating or Orlistat for patients requiring non-systemic options.
3. Asian Perspectives & Practical Management: We will present data confirming that Asian populations, who are highly sensitive to metabolic risks, achieve weight loss efficacy comparable to Western populations with Semaglutide and Tirzepatide (STEP-7, SURMOUNT-CN/J). Finally, we will address practical strategies for dose titration to mitigate GI adverse events and emphasize the necessity of chronic treatment to prevent weight regain.
This presentation aims to equip clinicians with a precision medicine approach, ensuring the right AOM is prescribed to maximize both weight reduction and holistic health outcomes.
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Jenny GuntonAustralia
Speaker
Closing the Type 2 Diabetes Gap in Cardiovascular and Renal DiseasePeople with type 2 diabetes die, on average, 6-7 years earlier. This is mostly due to excess cardiovascular events.
This presentation will discuss options for lowering cardiovascular and renal risk in people with type 2 diabetes.Managing Hyperglycaemia in Patients Receiving Immune Checkpoint InhibitorsIt is estimated that >20% of people treated with Immune Checkpoint Inhibitors (ICI) for their cancer will experience new or worsening hyperglycaemia.
This presentation will discuss the differential diagnoses for the cause of hyperglycaemia in people treated with ICI and treatment strategies
101
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Preoperative Thyroid Nodule Diagnosis
Chia-Hung LinTaiwan
Moderator
Novel Biomarkers and Treatment Strategies in Thyroid Eye DiseaseThyroid Eye Disease (TED), also known as Graves' orbitopathy, remains a complex autoimmune condition that significantly impacts patients' vision and quality of life. Traditionally, management has relied mainly on non-specific anti-inflammatory therapies. However, as our understanding of its molecular pathogenesis evolves, there is an increasing clinical demand for more precise diagnostic tools and targeted therapeutic interventions.
This presentation provides a comprehensive overview of the current landscape and future directions in the management of TED. We will discuss the emergence of novel serum and molecular biomarkers that offer potential for earlier diagnosis and more accurate prediction of disease progression. These biomarkers may bridge the gap between clinical observation and underlying immunological activity. Furthermore, we will explore the shift in treatment paradigms, moving from conventional systemic corticosteroids toward innovative biological agents. By targeting specific signaling pathways involved in orbital inflammation and remodeling, these new strategies aim to provide more effective and durable clinical outcomes.
The integration of novel biomarkers and advanced treatment modalities is reshaping the management of TED. Moving toward a more individualized approach will allow clinicians to optimize therapeutic timing and selection, ultimately improving the long-term prognosis for patients with this challenging condition.
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Guodong FuCanada
Speaker
Preoperative Molecular Testing for Thyroid NodulesTitle: Preoperative Quantitative Molecular Testing for a Definitive Cancer Diagnosis among Patients with Thyroid Nodules
Objective: Molecular testing is increasingly used in the assessment of thyroid nodules. Tumors harboring the same genomic variant may not behave the same because a gene variant is not expressed equally in tumor cells among patients. This study is to delineate interpatient variabilities in genomic variants in thyroid tumors and assess their diagnostic significance in definitive thyroid cancer diagnosis.
Methods: Interpatient differences in BRAF V600E, TERT promoter, and RAS variants (ie, NRAS, HRAS, and KRAS) were analyzed in residual thyroid fine-needle aspiration (FNA) biopsies and compared with surgical histopathologic diagnoses. Malignancy rates, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated.
Results: This retrospective study enrolled 620 patients (470 [75.8%] female; mean [SD] age, 50.7 [15.9] years), including 438 surgically resected thyroid tumors and 249 thyroid nodule FNA biopsies. Of 438 tumors, 178 (40.6%) and 58 (13.2%) carcinomas were detected with interpatient variabilities of BRAF V600E and TERT promoter variants (C228T and C250T), with variant allele fraction (VAF) levels ranging from 0.03% to 48.56% and 0.13% to 54.74%, respectively. Furthermore, 89 (20.3%) were identified with the presence of RAS variants, including 51 (11.6%) with NRAS, 29 (6.6%) with HRAS, and 9 (2.1%) with KRAS, with VAF levels ranging from 0.15% to 51.53%. VAF assays of 249 residual FNA specimens identified 50 specimens (20.1%) with BRAF V600E, 25 FNAs (10.0%) with TERT promoter variants, and 36 specimens (14.5%) with RAS variants with interpatient variabilities (including 23 FNAs [9.2%] with NRAS, 10 FNAs [4.0%] with HRAS, and 3 FNAs [1.2%] with KRAS). Interpatient differences in the 5 gene variants (NRAS, HRAS, KRAS, BRAF, and TERT) were detected in 54 of 126 indeterminate FNAs (42.9%) and 18 of 76 ND FNAs (23.7%). Compared with the 5 gene variants detected in the matched surgical specimens, VAF assays on residual FNA biopsies exhibited a high agreement (κ = 0.80; P < .001) and demonstrated a sensitivity of 87.1% (95% CI, 69.2%-95.8%), specificity of 92.5% (95% CI, 78.5%-98.0%), PPV of 90.0% (95% CI, 72.3%-97.4%), and NPV of 90.2% (95% CI, 75.9%-96.8%).
Conclusions: This diagnostic study delineated that quantitative discrimination of interpatient variabilities in genomic variants could facilitate cytology examinations in preoperative precision malignancy diagnosis among patients with thyroid nodules.
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Samantha Peiling YangSingapore
Speaker
Harnessing Molecular Diagnostics in Cytologically-Indeterminate Thyroid NodulesRe-Differentiation Therapy in RAI-Refractory Thyroid Cancer
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102
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Environmental Hormones
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Ching Chang LeeTaiwan
Speaker
Endocrine Disrupting Chemicals Exposure and Human Health Outcomes in Different PopulationsUp to now, public concerns about the impact of EDCs on human health is growing steadily. Phthalates are thyroid, reproductive and developmental toxicants. Maternal hypothyroidism during pregnancy can cause adverse effects in the fetus. Study 1 investigates the association between phthalate exposure and thyroid hormones in pregnant women. After adjusting for age, BMI and gestation, urinary MBP levels showed negative associations with FT4 and T4 (FT4: = -0.110, P < 0.001; T4: = -0.112, P = 0.003). Exposure to di-n-butyl phthalate (DBP) may affect thyroid activity in pregnant women. Study 2 evaluates the association between maternal urine excretion, the exposure of fetus to phthalates in amniotic fluid, and the health of newborns. We found a significant positive correlation between creatinine adjusted urinary MBP and amniotic fluid MBP (R2=0.156, P <0.05) in all infants and, only in female infants, a significantly negative correlation between amniotic fluid MBP, AGD (R = −0.31, P <0.06), and the anogenital index adjusted by birth weight (AGI-W) (R = −0.32, P <0.05). Our data clearly show that in utero exposure to phthalates in general has anti-androgenic effects on the fetus. Study 3 investigates the association between exposure to phthalates and female puberty, and assesses the effect of leuprorelin acetate treatment on kisspeptin-54 secretion in girls with CPP. All seven urinary phthalate metabolites in the CPP group were significantly higher than in prepubescent controls. Serum kisspeptin-54 level were higher (P = 0.022) in the CPP group than control group and still significantly higher after adjusting for age (P = 0.03). There was a significant increasing trend (Ptrend = 0.005) between levels of kisspeptin and the stages of puberty. Significantly positive correlation between kisspeptin-54 and urinary MBP (R2 = 0.109, P = 0.024) was found. Study 4 explores the biomarkers of altered testicular function associated with exposure to phthalates: the testosterone and INSL3 secretion of adult men with different fertility states. In multiple regression models controlled for potential confounders, there is an inverse association between urinary levels of MMP), mono-iso-butyl phthalate (MiBP), MEHP, MEHP% and serum TT (P = 0.001, 0.007, 0.042 and 0.012). The inverse associations were also found between urinary levels of MiBP, MBzP, MEHP, MEHP% and serum fT (P = 0.028, 0.017, 0.045 and 0.027). Urinary MBzP and MEHP% were negatively associated with a decrease in serum INSL3 (P = 0.049 and 0.001). We also observed a strong inverse relationship between MEHP% quartiles and serum TT, fT, the TT : LH ratio and INSL3 (Ptrend = 0.003, 0.080, 0.002 and 0.012). Serum INSL3, TT, fT and the TT : LH ratio were lower for men in the highest MEHP% quartile than in the reference group (P = 0.007, 0.002, 0.090 and 0.001). In conclusion, the present study showed that infertile men had poor Leydig cell functionality, higher levels of urinary phthalate metabolites and lower concentrations of androgens or INSL3, or both, which implied that being exposed to phthalates might affect human testicular steroidogenesis by impairing the function of Leydig cells. Study 5 investigated the active mechanisms of how being exposed to phthalates affects the imbalance of androgen and estrogen and the generation of ROS to determine whether both mediated phthalate-induced effects are involved in prostatic enlargement. DEHP metabolite levels, particularly urinary MEHP, were positively associated with androgen, estrogen, hormone ratios, inducible nitric oxide synthetase (iNOS), 8-OHdG, prostate specific antigen (PSA), and prostate volume (PV) (P < 0.05). PV and PSA were positively associated with androgen, estrogen, hormone ratios and oxidative stress markers (P < 0.05). The estimated percentages of exposure to phthalates in prostatic enlargement mediated by androgen, estrogen, and OS markers ranged from 3.5% to 63.1%. Exposure to DEHP promoted the progress of BPH by increasing dihydrotestosterone (DHT), estradiol (E2), the converted enzymes aromatase and 5 reductase, and reactive oxygen species (8-OHdG and iNOS) production. Sex hormones and OS might be important hyperplasia-promoters after a patient has been exposed to phthalates, especially to DEHP.
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Vina Yanti SusantiIndonesia
Speaker
Environmental Endocrinology: Interactions Between Environment and Hormonal SystemsEnvironmental Endocrinology: Interactions Between Environment and Hormonal System
Vina Yanti Susanti1
1 Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Gadjah
Mada University, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Abstract
The endocrine system serves as a sophisticated regulatory network essential for maintaining homeostasis, growth, and reproductive health through precise hormonal signaling. However, increasing exposure to environmental stressors—specifically Endocrine Disrupting Chemicals (EDCs)—has been shown to interfere with these pathways, posing significant risks to human health. This review explores the complex interactions between environmental pollutants and the hormonal system by dissecting the ten key functional characteristics of EDCs.
The analysis categorizes these interactions into direct and indirect mechanisms. We examine how EDCs act as receptor agonists or antagonists, blocking natural hormones, and how they modulate receptor expression and signal transduction pathways. Furthermore, the review highlights the molecular impact of EDCs on epigenetic alterations, such as DNA methylation and histone modification. At the systemic level, we discuss the disruption of hormone synthesis, transport, distribution, and clearance. Finally, the review addresses the downstream consequences on cellular fate, including dysregulated proliferation, differentiation, and apoptosis.
By integrating these ten dimensions, this paper emphasizes that environmental endocrine disruption is a multifaceted process rather than a single-point failure. Elucidating these integrated mechanisms provides a profound understanding of how environmental factors interact with and fundamentally reshape the body's internal hormonal landscape.
Keywords: Environmental Endocrinology, Endocrine-Disrupting Chemicals (EDCs), Key Characteristic of Endocrine Disrupting Chemicals
201BC
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12:10
13:00
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Lunch Symposium 【Acer Medical Inc.】
102
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RFA Lunch Symposium 【STARMED Co., Ltd.】
201AF
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Lunch Symposium 【Sanofi】
201BC
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12:30
15:30
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Chia-Luen HuangTaiwan
Speaker
Group instructions Thyroid tumor is one of the most common endocrine abnormalities, and its incidence has been steadily rising over recent decades. While traditional treatments often involve surgery and active surveillance, advancements in minimally invasive techniques have introduced radiofrequency ablation (RFA) and microwave ablation (MWA) as a viable alternative. The workshop delves into the role of radiofrequency ablation and other minimally intervention therapies in treating thyroid tumors, highlighting its benefits, procedures, and considerations.
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Chia-Luen HuangTaiwan
Speaker
Group instructions Thyroid tumor is one of the most common endocrine abnormalities, and its incidence has been steadily rising over recent decades. While traditional treatments often involve surgery and active surveillance, advancements in minimally invasive techniques have introduced radiofrequency ablation (RFA) and microwave ablation (MWA) as a viable alternative. The workshop delves into the role of radiofrequency ablation and other minimally intervention therapies in treating thyroid tumors, highlighting its benefits, procedures, and considerations.
He-Jiun JiangTaiwan
Speaker
Redifferentiation Strategies in Refractory Thyroid Cancer: First Insights from TaiwanBackground: Patients with BRAF p.V600E-mutated radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) face a poor prognosis. While MAPK pathway inhibition can restore radioiodine (RAI) avidity, standard full-dose protocols (e.g., MERAIODE) are often associated with significant toxicity (Grade 3/4 adverse events >20%). This study investigates the efficacy and safety of a novel low-dose, pulsed redifferentiation strategy in a real-world Asian cohort.
Methods: We conducted a retrospective cohort study of 24 patients with metastatic BRAF p.V600E RAIR-PTC. Patients received a 60-day induction regimen of Dabrafenib (75 mg BID) and Trametinib (2 mg QOD, every other day). A "Treat-All" strategy was employed, omitting diagnostic scanning to avoid stunning effects, followed by a fixed therapeutic dose of 131-I (150-200 mCi). Primary endpoints included RAI uptake restoration, objective response rate (ORR), disease control rate (DCR), and safety profile.
Results: RAI avidity was restored in 83.3% of patients. The regimen demonstrated an exceptional safety profile without Grade 3/4 adverse events. While the ORR was 16.7%, the DCR reached 83.3% at 6 months. Age <55 years was identified as the most significant predictor for objective tumor regression (p=0.007). Furthermore, the study highlights the clinical value of "TKI-Free Survival," with 88.9% of prior TKI users achieving a sustained drug holiday.
Conclusion: The low-dose, pulsed BRAF/MEK inhibition protocol offers a highly tolerable and effective redifferentiation strategy. While tumor shrinkage is less pronounced than with full-dose regimens, the high rate of disease control and excellent safety profile make it a viable option for stabilizing disease and improving quality of life, particularly for younger patients (<55) or those intolerant to standard TKI therapy.
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201AF
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13:10
13:40
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Diabetes Mellitus
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Jenny GuntonAustralia
Speaker
Closing the Type 2 Diabetes Gap in Cardiovascular and Renal DiseasePeople with type 2 diabetes die, on average, 6-7 years earlier. This is mostly due to excess cardiovascular events.
This presentation will discuss options for lowering cardiovascular and renal risk in people with type 2 diabetes.Managing Hyperglycaemia in Patients Receiving Immune Checkpoint InhibitorsIt is estimated that >20% of people treated with Immune Checkpoint Inhibitors (ICI) for their cancer will experience new or worsening hyperglycaemia.
This presentation will discuss the differential diagnoses for the cause of hyperglycaemia in people treated with ICI and treatment strategies
102
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Obesity
Edy KorneliusTaiwan
Moderator
Anxiety in Patients with Thyroid Nodules: What Clinicians Need to KnowThyroid nodules are commonly encountered in endocrine practice, and while the majority are benign, the diagnostic and surveillance process often imposes a substantial psychological burden on patients. Anxiety related to fear of malignancy, uncertainty surrounding ultrasonographic findings, fine-needle aspiration results, and long-term follow-up is frequently underestimated and insufficiently addressed in routine clinical care. Emerging evidence suggests that anxiety in patients with thyroid nodules may persist even after reassurance of benign disease and can significantly affect quality of life, healthcare utilization, and decision-making preferences.
Cancer-related worry is often disproportionate to the actual risk of malignancy and may be exacerbated by repeated imaging, indeterminate cytology, ambiguous terminology, and lack of clear follow-up strategies. Heightened anxiety has been associated with increased demand for diagnostic interventions and preference for aggressive management, potentially leading to overtreatment.
This presentation reviews current evidence on the prevalence, determinants, and clinical consequences of anxiety among patients with thyroid nodules, integrating published literature with real-world clinical experience. Practical approaches for identifying psychological distress in outpatient settings and strategies for improving communication and expectation management will be discussed. Recognizing and addressing anxiety as an integral component of thyroid nodule care is essential for delivering holistic, patient-centred, and value-based endocrinology.
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Alice KongHong Kong, China
Speaker
Obesity: What Clinicians Should KnowRapid changes in technology, human behavior and lifestyle over the past few decades have resulted in a dramatic increase in the prevalence of obesity worldwide. Besides social stigmata and psychological consequences, obesity is associated with escalated risks of type 2 diabetes, coined the term "Diabesity", hypertension, dyslipidemia, sleep apnoea, metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), polycystic ovarian syndrome, cancers, cardiovascular diseases and increased mortality.
Body mass index (BMI) is a commonly adopted tool to identify people with obesity. Clinicians should note that the cutoff points of BMI for clinical actions are different between people with obesity from the East and the West, as well as the limitations of BMI in diagnosing obesity. Recently, the Lancet Diabetes and Endocrinology Commission proposed a new definition of obesity which differentiates excess adiposity with obesity-related illness (clinical obesity) from those without obesity-related diseases (pre-clinical obesity). Also, people with clinical obesity have many unmet needs requiring personalized treatment regimens, intensive counselling and emotional support. The 5 A's framework including Ask, Assess, Advise, Agree and Assist, provide a patient-centred approach to promote lasting behavioral change in obesity management.
In addition to lifestyle modifications and behavioral changes, pharmacological agents for weight reduction, bariatric and metabolic surgeries are therapeutic options requiring careful selections for the appropriate patients with adequate counselling of the risks and benefits. Through case sharing approach, the use of weight reducing drugs and surgical strategies for people with preclinical and clinical obesity will be discussed in this session.
Acknowledgement: The work described in this lecture was partially supported by funding from Health and Medical Research Fund (HMRF), Food and Health Bureau, Hong Kong SAR, China (Reference number:21223391), Matching Grant from Research Grants Council (reference number: 8601556), and Area of Excellence Scheme, Research Grants Council, Hong Kong SAR, China (Reference number: AoE/M-401/24-R). Obesity Management: What's New?Obesity is a global health hazard with rising prevalence in most parts of the world. Weight reduction by lifestyle modification remains the cornerstone in the prevention and treatment of obesity. However, weight management by lifestyle therapy alone is difficult to sustain in many obese individuals with rebound of body weight being observed as a common phenomenon. Given the invasiveness of bariatric and metabolic surgeries which are not accepted by many people with obesity, the use of pharmacological agents in weight management is increasingly popular.
In 2025, the Lancet Diabetes and Endocrinology Commission proposed a new definition of obesity which differentiates excess adiposity with obesity-related illness (clinical obesity) from those without obesity-related diseases (pre-clinical obesity). Among the various obesity complications, diabetes is well recognized to be closely related to obesity, with the term 'Diabesity' coined to show the strong link between these two important modifiable risk factors of cardiovascular disease and premature death. In recent decades, many new generation anti-diabetic drugs are developed and found to have weight reducing properties. Looking ahead, more new drugs are in the pipeline of clinical trials, and the results may eventually change the landscape of obesity management.
Acknowledgement: The work described in this lecture was partially supported by funding from Health and Medical Research Fund (HMRF), Food and Health Bureau, Hong Kong SAR, China (Reference number:21223391), Matching Grant from Research Grants Council (reference number: 8601556), and Area of Excellence Scheme, Research Grants Council, Hong Kong SAR, China (Reference number: AoE/M-401/24-R).
201BC
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Environmental Hormone
Ching Chang LeeTaiwan
Moderator
Endocrine Disrupting Chemicals Exposure and Human Health Outcomes in Different PopulationsUp to now, public concerns about the impact of EDCs on human health is growing steadily. Phthalates are thyroid, reproductive and developmental toxicants. Maternal hypothyroidism during pregnancy can cause adverse effects in the fetus. Study 1 investigates the association between phthalate exposure and thyroid hormones in pregnant women. After adjusting for age, BMI and gestation, urinary MBP levels showed negative associations with FT4 and T4 (FT4: = -0.110, P < 0.001; T4: = -0.112, P = 0.003). Exposure to di-n-butyl phthalate (DBP) may affect thyroid activity in pregnant women. Study 2 evaluates the association between maternal urine excretion, the exposure of fetus to phthalates in amniotic fluid, and the health of newborns. We found a significant positive correlation between creatinine adjusted urinary MBP and amniotic fluid MBP (R2=0.156, P <0.05) in all infants and, only in female infants, a significantly negative correlation between amniotic fluid MBP, AGD (R = −0.31, P <0.06), and the anogenital index adjusted by birth weight (AGI-W) (R = −0.32, P <0.05). Our data clearly show that in utero exposure to phthalates in general has anti-androgenic effects on the fetus. Study 3 investigates the association between exposure to phthalates and female puberty, and assesses the effect of leuprorelin acetate treatment on kisspeptin-54 secretion in girls with CPP. All seven urinary phthalate metabolites in the CPP group were significantly higher than in prepubescent controls. Serum kisspeptin-54 level were higher (P = 0.022) in the CPP group than control group and still significantly higher after adjusting for age (P = 0.03). There was a significant increasing trend (Ptrend = 0.005) between levels of kisspeptin and the stages of puberty. Significantly positive correlation between kisspeptin-54 and urinary MBP (R2 = 0.109, P = 0.024) was found. Study 4 explores the biomarkers of altered testicular function associated with exposure to phthalates: the testosterone and INSL3 secretion of adult men with different fertility states. In multiple regression models controlled for potential confounders, there is an inverse association between urinary levels of MMP), mono-iso-butyl phthalate (MiBP), MEHP, MEHP% and serum TT (P = 0.001, 0.007, 0.042 and 0.012). The inverse associations were also found between urinary levels of MiBP, MBzP, MEHP, MEHP% and serum fT (P = 0.028, 0.017, 0.045 and 0.027). Urinary MBzP and MEHP% were negatively associated with a decrease in serum INSL3 (P = 0.049 and 0.001). We also observed a strong inverse relationship between MEHP% quartiles and serum TT, fT, the TT : LH ratio and INSL3 (Ptrend = 0.003, 0.080, 0.002 and 0.012). Serum INSL3, TT, fT and the TT : LH ratio were lower for men in the highest MEHP% quartile than in the reference group (P = 0.007, 0.002, 0.090 and 0.001). In conclusion, the present study showed that infertile men had poor Leydig cell functionality, higher levels of urinary phthalate metabolites and lower concentrations of androgens or INSL3, or both, which implied that being exposed to phthalates might affect human testicular steroidogenesis by impairing the function of Leydig cells. Study 5 investigated the active mechanisms of how being exposed to phthalates affects the imbalance of androgen and estrogen and the generation of ROS to determine whether both mediated phthalate-induced effects are involved in prostatic enlargement. DEHP metabolite levels, particularly urinary MEHP, were positively associated with androgen, estrogen, hormone ratios, inducible nitric oxide synthetase (iNOS), 8-OHdG, prostate specific antigen (PSA), and prostate volume (PV) (P < 0.05). PV and PSA were positively associated with androgen, estrogen, hormone ratios and oxidative stress markers (P < 0.05). The estimated percentages of exposure to phthalates in prostatic enlargement mediated by androgen, estrogen, and OS markers ranged from 3.5% to 63.1%. Exposure to DEHP promoted the progress of BPH by increasing dihydrotestosterone (DHT), estradiol (E2), the converted enzymes aromatase and 5 reductase, and reactive oxygen species (8-OHdG and iNOS) production. Sex hormones and OS might be important hyperplasia-promoters after a patient has been exposed to phthalates, especially to DEHP.
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Pau-Chung ChenTaiwan
Speaker
PFAS Exposure and Human Health from Ubiquity to UrgencyPer- and polyfluoroalkyl substances (PFAS), often referred to as “forever chemicals,” are ubiquitous environmental contaminants widely used in industrial and consumer applications. Due to their extreme persistence, bioaccumulation potential, and endocrine-disrupting properties, PFAS have emerged as a major global public health concern. Our research team has conducted a comprehensive and systematic investigation into the human health effects of PFAS across the life course, integrating epidemiological analyses, biomonitoring, and biomarker-based approaches.
Our findings demonstrate that PFAS exposure is associated with a broad spectrum of adverse health outcomes. In early life, prenatal and childhood exposure to PFAS has been linked to reduced fetal and childhood growth, disrupted thyroid function, delayed neurodevelopment, increased symptoms of attention deficit/hyperactivity disorder, elevated immunoglobulin E levels, impaired lung function development, and increased risks of childhood asthma. We have also identified associations with altered sex hormone profiles, including reduced testosterone and increased estradiol levels, as well as elevated uric acid concentrations.
In adolescents and adults, our collaborative studies further indicate that PFAS exposure interferes with reproductive hormone regulation, accelerates subclinical atherosclerosis—as evidenced by increased carotid intima-media thickness—and elevates the risks of metabolic syndrome, diabetes, and premenopausal breast cancer. Collectively, these findings provide compelling evidence that PFAS exert multi-system effects spanning growth and development, neurobehavior, immune function, cardiometabolic health, and reproductive outcomes, thereby establishing a globally recognized body of evidence on PFAS-related health risks.
Beyond scientific discovery, this lecture highlights how epidemiological evidence has informed policy action in Taiwan. In response to mounting health concerns, the use of PFOS was completely phased out beginning in 2017, followed by the progressive replacement of PFOA and related chemicals. PFHxS was subsequently designated as a toxic chemical substance and was effectively banned by the end of 2023, with limited exemptions for research and educational purposes. In 2024, the Executive Yuan approved the national Action Plan for the Management of Per- and Polyfluoroalkyl Substances, marking a critical step toward comprehensive PFAS governance.
This lecture underscores the urgent need to translate scientific evidence into preventive action and demonstrates how sustained research can catalyze regulatory change. Addressing PFAS contamination will require coordinated efforts across science, industry, and policy to protect current and future generations from the long-term health consequences of these persistent chemicals.
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Oral Presentation 2: Precision Diabetes: Management & Renal Protection
Noriko Satoh-AsaharaJapan
Moderator
MASLD and Cognitive Impairment Correlate with Diabetic ManagementIn recent years, the coexistence of metabolic dysfunction–associated steatotic liver disease (MASLD) and cognitive decline in patients with diabetes has attracted growing attention. These conditions are not merely concurrent comorbidities but share common pathophysiological mechanisms involving insulin resistance, chronic inflammation, and gut dysbiosis. Using a large health checkup database, we reported that a body weight gain of more than 10 kg since the age of 20 is a significant risk factor for the development of MASLD (Nutrients, 2025). Moreover, we found that subsequent weight reduction markedly attenuated this risk, emphasizing the importance of appropriate weight management. In our multicenter diabetic cohort studies of the National Hospital Organization (JOMS/J-DOS2), we reported that circulating soluble TREM2 (sTREM2) —a receptor specifically expressed in monocytes and microglia—was significantly associated with cognitive decline in patients with diabetes, suggesting its potential as a predictive biomarker for dementia (Diabetes Metab, 2019; Front Endocrinol, 2022). Furthermore, our network meta-analysis in patients with type 2 diabetes revealed that SGLT2 inhibitors, GLP-1 receptor agonists, and thiazolidinediones may reduce the risk of cognitive impairment (Diabetes Obes Metab, 2025). Novel antidiabetic agents, particularly GLP-1 receptor agonists, have been shown to improve hepatic function and preserve cognitive performance. Collectively, these findings suggest that optimized diabetic management may hold the key to preventing both MASLD and dementia. In this presentation, I would like to summarize recent evidence and discuss optimal therapeutic strategies for MASLD and cognitive impairment in patients with diabetes.
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Thyroid Eye Disease Management
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Chia-Hung LinTaiwan
Speaker
Novel Biomarkers and Treatment Strategies in Thyroid Eye DiseaseThyroid Eye Disease (TED), also known as Graves' orbitopathy, remains a complex autoimmune condition that significantly impacts patients' vision and quality of life. Traditionally, management has relied mainly on non-specific anti-inflammatory therapies. However, as our understanding of its molecular pathogenesis evolves, there is an increasing clinical demand for more precise diagnostic tools and targeted therapeutic interventions.
This presentation provides a comprehensive overview of the current landscape and future directions in the management of TED. We will discuss the emergence of novel serum and molecular biomarkers that offer potential for earlier diagnosis and more accurate prediction of disease progression. These biomarkers may bridge the gap between clinical observation and underlying immunological activity. Furthermore, we will explore the shift in treatment paradigms, moving from conventional systemic corticosteroids toward innovative biological agents. By targeting specific signaling pathways involved in orbital inflammation and remodeling, these new strategies aim to provide more effective and durable clinical outcomes.
The integration of novel biomarkers and advanced treatment modalities is reshaping the management of TED. Moving toward a more individualized approach will allow clinicians to optimize therapeutic timing and selection, ultimately improving the long-term prognosis for patients with this challenging condition.
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Ichiro YamauchiJapan
Speaker
Management of Thyroid Eye Disease: Insights from Clinical Experience and MRI Findings in JapanIn Japan, disease activity of thyroid eye disease (TED) is commonly assessed using magnetic resonance imaging (MRI) in addition to clinical activity score (CAS). Recently, we proposed an MRI-guided categorization of active moderate-to-severe TED based on our retrospective data.
We retrospectively analyzed TED cases treated at our department between 2015 and 2022 with a combination of daily steroid pulse therapy and orbital radiation. Among 44 cases with diplopia, we classified 17 cases as severe (diplopia in the primary position) and 27 as non-severe (diplopia only in non-primary positions). The severe group was older (median 67 years) and had lower TSAb titers (median 324%) compared to the non-severe group (median 56 years, median TSAb 2443%). CAS was similar between the groups. MRI revealed that proptosis was more pronounced in the non-severe group (median 21.4 mm) than in the severe group (median 17.5 mm), whereas the difference in proptosis between eyes was larger in the severe group (median 2.0 mm) than in the non-severe group (median 0.9 mm). High signal intensity of orbital fat on STIR sequence was more frequently observed in the non-severe group (68.2%) than in the severe group (20.0%).
These findings suggest that TED patients with severe diplopia are characterized by older age, lower TSAb titers, and greater asymmetry in proptosis. In contrast, CAS and STIR signal intensity of orbital fat were not indicative of severity. In this context, severe diplopia often develops despite low CAS and mild proptosis.
We also present our clinical experience with teprotumumab, an anti–IGF-1 receptor antibody. Since its launch in Japan in 2024, we have treated several patients with severe TED, the majority of whom showed remarkable improvement in clinical features. However, adverse effects such as hearing impairment and hyperglycemia were occasionally observed, highlighting the importance of appropriate management.
In conclusion, MRI-guided evaluation provides valuable insights for individualized management of TED. Evidence regarding the efficacy of teprotumumab remains limited in the subtype characterized by severe diplopia, which often presents with low CAS and mild proptosis. The MRI-guided approach may help clinicians select optimal therapeutic strategies, including steroid pulse therapy, teprotumumab, and other emerging agents.
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Kelvin ChongHong Kong, China
Speaker
Update on Thyroid Eye Disease Management - Asia Pacific PerspectivesExisting guidelines/recommendations/consensus on the management of thyroid eye disease (TED)/Graves' orbitopathy (GO) pose significant difficulties when applied in the Asia Pacific region. The presenter will share his experiences and challenges in setting up the first thyroid eye clinic in Hong Kong, developing an image-guided medical and surgical decompression, while looking into the future of intelligence-based management of TED/GO.
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Gestational Diabetes in Asian Countries
Hung-Yuan LiTaiwan
Moderator
Diagnosis and Evaluation of ObesityObesity is now widely recognized as a chronic, heterogeneous disease rather than a simple consequence of excess body weight. Contemporary perspectives emphasize that obesity-related health risk arises not only from the quantity of adipose tissue, but also from its distribution and functional status. In recent years, major international organizations—including the The Lancet Commission on Obesity, the American Association of Clinical Endocrinology (AACE), the European Association for the Study of Obesity (EASO), the Japan Society for the Study of Obesity (JASSO), and the American Diabetes Association (ADA)—have proposed evolving frameworks for obesity diagnosis that move beyond reliance on body mass index (BMI) alone.
This session will review current concepts in the diagnosis and evaluation of obesity, integrating anthropometric measures, adiposity distribution, obesity-related complications, and functional consequences of excess fat. While BMI remains a practical and widely used screening tool, its limitations at the individual level are increasingly recognized. Complementary measures such as waist circumference and waist-to-height ratio provide important additional information, particularly for assessing central adiposity and cardiometabolic risk in Asian populations.
A central theme of this lecture is the concept of obesity-related complications and diseases (ORCD), which can be broadly categorized into two interrelated entities. Fat mass disease refers to conditions driven predominantly by excessive fat mass and its mechanical or quantitative burden, whereas sick fat disease reflects adipose tissue dysfunction characterized by abnormal endocrine, inflammatory, and metabolic signaling. Both entities contribute to ORCD, either independently or in combination, and together account for the heterogeneous clinical manifestations of obesity.
According to the definitions proposed by the Lancet Commission on Obesity, obesity can be conceptualized along a continuum from preclinical obesity to clinical obesity. Preclinical obesity is characterized by excess adiposity without established ORCD and corresponds conceptually to AACE stage 1, representing a key opportunity for primary prevention. In contrast, clinical obesity is defined by the presence of ORCD and aligns with AACE stage 2 and stage 3, in which clinical management focuses on secondary prevention, risk reduction, and complication management. This integration of Lancet Commission concepts with AACE staging provides a disease-oriented framework for risk stratification and therapeutic decision-making.
Comprehensive obesity evaluation must also address psychological, behavioral, and socio-cultural factors. Mental health conditions such as binge-eating disorder, depression, and anxiety may both contribute to and result from obesity, forming bidirectional relationships that influence disease trajectory. In addition, weight stigma, health literacy, and environmental and cultural contexts significantly affect treatment acceptance, adherence, and long-term outcomes, and should be incorporated into routine clinical assessment.
In conclusion, this session will propose a pragmatic, stepwise approach to obesity diagnosis and evaluation that integrates ORCD phenotyping with AACE stage 1–3 classification and the conceptual framework of the Lancet Commission. This approach is intended not only to inform clinical decision-making, but also to serve as the foundation for the forthcoming obesity-related clinical practice guidelines of the Diabetes Association of the Republic of China, bridging global concepts with local implementation.
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Ling-Jun LiSingapore
Speaker
Is Continuous Glucose Monitoring Ready for Screening and Monitoring of Gestational Diabetes in Asian Populations?Gestational diabetes mellitus (GDM) is highly prevalent across Asia, where genetic susceptibility, rapid urbanization, and uneven access to antenatal care contribute to rising maternal and neonatal complications. Current screening and monitoring rely on oral glucose tolerance testing (OGTT) and self-monitored blood glucose (SMBG), but both have limitations, including sparse capture of glycaemic variability, patient burden, and missed postprandial excursions. Continuous glucose monitoring (CGM) provides near real-time glucose profiles that can support more responsive management, and emerging studies suggest that early-pregnancy CGM metrics may help predict GDM diagnosed later in pregnancy. However, the evidence remains heterogeneous, with variation in diagnostic criteria, population characteristics, device type, adherence, and background care pathways.
Given Asia’s high and growing GDM burden, region-specific evidence is needed to inform guideline and policy development. This talk will synthesize findings from Asian studies, with a particular focus on work from Singapore, and discuss what is required for CGM to move from promising tool to routine practice in GDM screening and management in Asian populations.
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Hirohito SoneJapan
Speaker
The Impact of Underweight in Young Women on GDM and the Next Generation In Japan and some neighboring East Asian countries, it is somewhat surprising given their socio-economic level that underweight, rather than obesity, is a significant health issue for young women. According to the National Health and Nutrition Survey in Japan, the proportion of underweight women in their 20s (BMI < 18.5) has remained above 20% for decades. Despite this, many young women overestimate their own body size, with numerous individuals attempting to lose weight even though they are actually within the normal range. This reveals a discrepancy between perceived and actual body size, alongside the existence of a desire to be thin. The ideal thin body shape is influenced by social trends and traditional values that posit thinness as more attractive, as well as the influence of mass media and social media. Entertainers and fashion models are often seen as being too thin.
The health effects of being underweight in young women are known to include increased osteoporosis and mortality, but adverse effects on pregnancy and pregnancy outcomes have also been observed. Underweight women have a higher risk of gestational diabetes mellitus (GDM), a higher rate of low birth weight, and a lower birth rate compared to women of normal weight. Indeed, in Japan, the rate of low birth weight infants has been increasing in parallel with the proportion of thin women. Recent findings from DOHaD (Developmental Origins of Health and Disease) and fetal programming research have revealed that low birth weight infants face a higher future risk of developing metabolic diseases such as diabetes and hypertension. Consequently, maternal underweight before pregnancy and weight-control behaviors after pregnancy likely have adverse health effects on future generations. Based on this background, Japan has revised the standards for appropriate weight gain during pregnancy, and discussions are currently underway regarding GDM pregnant women. Furthermore, as part of preconception care, education on the importance of maintaining a healthy weight and body image is being promoted, starting from junior high and high school.
The trend toward underweight among young Japanese women, even during pregnancy, is a major national health issue, as it affects not only the health of the women themselves but also the next generation. However, its causes are complex, and multifaceted measures involving society as a whole are required. These countermeasures are also expected to be useful for prevention of same issues in other East Asian countries as well in the future.
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I-Lynn LeeAustralia
Speaker
Gestational Diabetes and Perinatal Outcomes in A Large Multi-Ethnic Australian PopulationGestational diabetes (GDM) is highly prevalent in a multi-ethnic Australian population in West Melbourne with high representation from South Asian, South East/Central Asian, Middle Eastern, African and Pacific communities. These ethnicities carry a disproportionate higher risk of GDM with earlier diagnosis in pregnancy.
Australia adoped the IADPSG screening method in 2015 for which GDM prevalence rose sharply there after accompanied by rising rates of maternal obesity and changes in migration patterns from high risk ethnicities.
GDM education is delivered in a group setting and sometimes individualised for culturally and liguistically diverse women. Dietary advice is also delivered in a culturally specific and sensitive manner. Treatment initiation differed with South Asian women requiring pharmacotherapy earlier and insulin use was highest among Middle Eastern women. A smartphone and internet based interactive glucose management system for managing women with GDM is being trialled with an aim to improve efficiency of care delivery.
Despite rising GDM prevalence and maternal obesity, the large for gestational age remains unchanged over time. Maternal BMI remains a dominant risk factor for LGA. Induction of labour rates also rose significantly over the last 10 years.
It is important to develop multilingual education resources and delivering culturally adapted nutritional counselling is essential to optimising care for women with GDM living in Melbourne's rapidly growing cultural diverse metropolitan communities.
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Update in Primary Aldosteronism
Mitsuhide NaruseJapan
Moderator
Update in Primary AldosteronismPrimary aldosteronism (PA) is linked to significantly greater cardiovascular morbidity and mortality than essential hypertension, yet it offers a more favorable prognosis when appropriately treated. Early detection and targeted therapy are therefore essential for achieving optimal long-term outcomes and preserving quality of life.
Since the release of the Endocrine Society’s guidelines in 2010, several countries—including Japan—have developed national recommendations (e.g., Endocrine Journal, 2021). This reflects growing awareness and research momentum, with over 3,500 publications in the past decade. In Japan, we have established a national PA registry and conducted multicenter studies under the Japan Primary Aldosteronism Study (JPAS), supported by AMED, resulting in more than 40 publications as Japan-originated evidence.
Diagnostic protocols have become increasingly standardized, encompassing initial screening, confirmatory testing, subtype classification via adrenal venous sampling (AVS), and tailored treatment—mineralocorticoid receptor (MR) antagonists for bilateral PA and adrenalectomy for unilateral PA. The integration of PA screening into routine hypertension care, alongside the standardization of diagnostic methods, has led to substantial improvements in clinical practice.
However, key challenges remain. These include variability in assay methods (e.g., PRA vs. ARC for renin; CLEIA vs. RIA for aldosterone), which affects diagnostic thresholds; uncertainty regarding optimal cutoffs for
screening and confirmatory tests; lack of consensus on AVS protocols (with or without cosyntropin); and ongoing debates over the role of non-invasive imaging and advanced surgical approaches (laparoscopic vs. robot-assisted adrenalectomy).
These unresolved issues warrant evaluation through a cost-effectiveness lens. As PA diagnostics become increasingly integrated into hypertension management, a fundamental question emerges: How far should we go in diagnosing PA? This presentation will provide an updated overview of clinical practice and address these critical challenges in PA management.Do We Still Need Confirmatory Testing?
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Hirotaka ShibataJapan
Speaker
2026 Update in Primary AldosteronismPrimary aldosteronism (PA) is one of the most prevalent causes for secondary hypertension. Early diagnosis and treatment are mandatory, because patients with PA present markedly higher morbidity of cardiovascular diseases than those with essential hypertension whose blood pressure levels are equally managed. A recently published Endocrine Society Clinical Practice Guideline of PA emphasizes several points. First, screening for PA with serum/plasma aldosterone concentration and plasma renin (concentration or activity) is recommended in all individuals with hypertension. Second, in individuals who screen positive for PA, aldosterone suppression testing is suggested when screening results suggest an intermediate probability for lateralizing PA, but not all cases. Third, in individuals with PA, medical therapy or surgical therapy with the choice of therapy based on lateralization of aldosterone hypersecretion and candidacy for surgery. Fourth, in individuals with PA considering surgery, adrenal lateralization with CT scanning and adrenal venous sampling prior to deciding the treatment approach is suggested. Fifth, in individuals with PA receiving PA-specific medical therapy, mineralocorticoid receptor antagonists (MRAs) are suggested as the dose is titrated by monitoring potassium, renal function, renin (concentration or activity) and blood pressure response during follow-up. We should be aware that diversity exists with respect to aldosterone assays, cut-off values for screening and aldosterone suppression tests, AVS standardization issues, and choice of MRAs depending on countries.
Diagnosis and Management of Adrenal InsufficiencyThe diagnosis and management of adrenal insufficiency presents major clinical challenges. It is often unrecognized, which can lead to adrenal crisis and, if not identified and treated, death. There is a lack of understanding on who is at risk of adrenal insufficiency, how to test for it, and how to manage a life threatening adrenal crisis promptly. While primary and secondary adrenal insufficiency can be regarded as rare conditions, glucocorticoid-induced adrenal insufficiency might be quite common. One should consider glucocorticoid withdrawal syndrome that may occur during glucocorticoid taper. Patient education in raising awareness of glucocorticoid withdrawal syndrome, such as fatigue and reduced appetite, is important when tapering glucocorticoid doses. The symptoms of glucocorticoid withdrawal syndrome may resemble adrenal insufficiency, but HPA axis is normally functional. The degree and persistence of adrenal suppression after cessation of glucocorticoid therapy are dependent on overall exposure and recovery of adrenal function varies greatly among individuals. Upcoming ICE2026/JES2026: Enlightened Endocrinology in Unprecedented TimesWe are pleased to announce that the 22nd International Congress of Endocrinology (ICE2026) and the 99th Annual Congress of the Japan Endocrine Society (JES2026) will be held together at the Kyoto International Conference Center (ICC Kyoto) over five days from June 2 (Tue) to 6 (Sat), 2026 (ICE2026/JES2026).
The International Congress of Endocrinology (ICE) is held every two years, and after 1988 and 2010, this will be the third time that the Congress will be held in Japan. The Japan Endocrine Society (JES) has been actively involved in the International Society of Endocrinology (ISE) since its establishment, and as the JES will celebrate its 100th anniversary in fiscal year 2026, hosting the congress in Japan will be an especially valuable opportunity for JES members.
The theme of ICE2026/JES2026 is: Enlightened Endocrinology in Unprecedented Times. Globally, we are entering an unprecedented era, including digitalization, which has been rapidly accelerated by the experience of the COVID-19 pandemic; a super-aging society, which is mainly faced by developed countries; and extreme weather events, as exemplified by global warming. In the midst of these unprecedented times, we will gather in Kyoto - the birthplace of the Japan Endocrine Society - to discuss the new century of clinical and basic research in various fields of endocrinology.
Participants from all over the world are encouraged to present cutting-edge science from their respective countries, and through active discussions, we hope that you will experience the “Enlightened Endocrinology” of endocrinology in this unprecedented era.
In June, flowers bloom profusely at shrines and temples in Kyoto with the blessings of water, and shrine gardens and hydrangea gardens are open to the public.
We look forward to welcoming participants from all over the world to Kyoto - the ancient capital of Japan - and discussing the future of endocrinology!
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Edith ChowHong Kong, China
Speaker
Personalizing Hypertension Treatment through Renin-Angiotensin-Aldosterone Physiology: Are We There Yet?Hypertension is the leading cardiovascular risk factor accounting for the global burden of cardiovascular disease and death. Renin-angiotensin-aldosterone-system takes a crucial role as the regulator in maintaining the body’s electrolyte homeostasis. RAAS overactivity is a key pathophysiological mechanism in hypertension. Dysregulation of the RAAS is closely tied to development of hypertension.
Primary aldosteronism is a disorder characterised by renin-independent aldosterone excess, manifesting as hypertension with greater risk of end-organ damage compared to individuals with essential hypertension. Recent guidelines for hypertension and primary aldosteronism have uniformly advocated for an expanded screening strategy for primary aldosteronism to improve awareness and detection of this treatable secondary cause of hypertension.
Traditionally, screening for primary aldosteronism has relied on the conception that it is a dichotomous condition. However, increasing evidence have suggested that renin and aldosterone abnormalities may exist on a continuum of clinical severity. In individuals with elevated blood pressure and family history of hypertension, higher levels of aldosterone are associated with greater risks of incident hypertension. Among normotensive individuals, the association between high aldosterone and incident hypertension were only evident among those with a suppressed renin, suggesting a phenotype of subclinical aldosterone excess. On the other hand, among individuals with resistant hypertension, targeting RAAS overactivity with mineralocorticoid antagonists have demonstrated superior blood pressure reduction compared to beta-blockers or alpha-blockers, especially in those with lower renin levels. With the development of novel treatments for hypertension that target RAAS, including aldosterone synthase inhibitors and non-steroidal mineralocorticoid inhibitors, there is growing interest in the role of RAAS hormones or metabolites as biomarkers to guide diagnosis, prognostication and management of hypertension.
Building upon this foundation, this talk will explore the potential role of aldosterone, renin and their metabolites as biomarkers in diagnosing and treating individuals with hypertension.
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Vincent WuTaiwan
Speaker
From Taiwan to the World: The TAIPAI Journey Transforming Primary AldosteronismPrimary aldosteronism (PA) is an increasingly recognized cause of secondary hypertension, affecting an estimated 5%-15% of hypertensive patients. This condition, once thought to be rare, is now understood to be a relatively common contributor to high blood pressure, particularly in cases resistant to standard antihypertensive therapies. PA arises primarily from either bilateral adrenal hyperplasia or an aldosterone-producing adenoma. The pathophysiology of PA is characterized by excessive and autonomous secretion of aldosterone, an adrenal hormone that plays a critical role in regulating blood pressure and fluid balance.
Diagnosing PA involves a multi-step process, beginning with screening tests to identify at-risk individuals, followed by confirmatory tests, and finally, subtype differentiation to determine the specific cause of the condition. Screening is especially recommended for patients who present with certain risk factors, such as resistant hypertension, unexplained hypokalemia, or an onset of hypertension at a young age (under 40 years). Family history of PA, early signs of target organ damage, the presence of an adrenal incidentaloma, obstructive sleep apnea, unexplained atrial fibrillation, and psychosomatic symptoms are also significant indicators warranting screening. Additionally, patients with hypertension but no other comorbidities should be evaluated for PA, as it could be the underlying cause.
PA does not occur in isolation; it is often found to coexist with Mild Autonomous Cortisol Secretion (MACS). This co-occurrence presents a more complex clinical picture, as MACS can further aggravate the cardio-renal-vascular complications already associated with PA. Moreover, it can contribute to abnormalities in glucose metabolism, increasing the risk of diabetes and other metabolic disorders. One of the key challenges in the diagnosis and management of PA, particularly when MACS is present, lies in accurately interpreting the aldosterone-to-cortisol ratios during adrenal venous sampling, a critical step in subtype differentiation.
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AI in Endocrinology
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Argon ChenTaiwan
Speaker
Advancement in AI Applications to Thyroid Nodule Detection and EvaluationDiagnosing thyroid cancer remains challenging due to overlapping imaging features between benign and malignant nodules, inherent limitations of current diagnostic tools, and substantial interobserver variability among clinicians. Although ultrasound is the first-line modality for thyroid nodule evaluation, interpretations of the same images often differ across physicians. The Thyroid Imaging Reporting and Data System (TI-RADS) was developed to standardize malignancy risk assessment; however, considerable variability in its application persists in clinical practice.
Artificial intelligence (AI) is increasingly transforming thyroid cancer diagnosis by enhancing accuracy, efficiency, and consistency in clinical decision-making. By leveraging machine learning and deep learning techniques, AI-based systems offer new opportunities to reduce subjectivity in ultrasound interpretation and support more personalized patient care. This talk will focus on recent advances in AI-assisted ultrasonographic detection and characterization of thyroid nodules.
Specifically, we will present evidence from Multi-Reader Multi-Case (MRMC) performance studies demonstrating how AI can improve diagnostic accuracy and inter-reader consistency across different TI-RADS guidelines. We will also compare the consistency of nodule interpretation across ultrasound systems between AI algorithms and human readers. Finally, a live demonstration of the AI software will illustrate its performance using ultrasound images from a wide spectrum of benign and malignant thyroid nodules.
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Yi-Jing ShenTaiwan
Speaker
Electronic Dashboard-Based Remote Glycemic Management Program Reduces Length of Stay and Readmission Rate among Hospitalized AdultsBackground: Inpatient dysglycemia is strongly associated with prolonged length of stay (LOS), increased readmission rates, and higher healthcare costs. Traditional consultation-based models are often insufficient for institution-wide glycemic quality improvement. With advances in electronic medical records (EMRs), real-time digital surveillance offers a scalable solution. We implemented a hospital-wide remote glycemic management program to evaluate its impact on glycemic control and clinical outcomes.
Methods: Building on our previously published framework, this institution-wide before-and-after study was conducted in a 1,500-bed tertiary medical center using data from 2016 to 2019 (106,528 hospitalized adults; 878,159 glucose measurements). The core intervention utilized an EMR-integrated dashboard to identify hyper-/hypoglycemia in real-time, enabling endocrinologists to provide daily virtual recommendations without formal consultation. Key components included automated risk stratification, real-time alerts, and department-specific performance feedback. Primary outcomes were LOS and 30-day readmission rates. Analyses were performed using Poisson and joinpoint regression with multivariable adjustment.
Results: Program implementation resulted in consistent and clinically significant improvements in hospital-wide glycemic metrics. Rapid improvement in treat-to-target rates was observed within 3–6 months of initiating virtual recommendations.
Clinical Outcomes: The program was associated with a significant reduction in LOS, independent of age, sex, and admission department. Notably, patients with high glucose variability exhibited the longest LOS, identifying glycemic instability as a key driver of resource utilization. Furthermore, 30-day readmission rates decreased significantly, particularly among patients achieving stable euglycemia.
Operational Efficiency & Pandemic Resilience: As glycemic quality improved, the time required for daily virtual recommendations decreased from ~2 hours to <1 hour. The program significantly reduced the need for formal consultations. Crucially, this established remote workflow proved vital during the COVID-19 pandemic, minimizing clinician exposure and preserving personal protective equipment (PPE) while maintaining high-quality glycemic care without disruption.
Conclusion: Integrating real-time EMR-based surveillance with remote endocrinologist-led intervention significantly improves inpatient glycemic control, translating into measurable reductions in LOS and 30-day readmission rates. This model has demonstrated sustained efficacy extending into the COVID-19 era and beyond, proving that an electronic dashboard-based system is a scalable, resilient, and resource-efficient strategy for modern hospital care.
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Jae Hoon MoonSouth Korea
Speaker
A New Era of Managing Thyroid Eye Disease: AI-Based Quantitative Monitoring and Precision CareThyroid Eye Disease (TED) is the most common extrathyroidal manifestation of autoimmune thyroid dysfunction, occurring in approximately 30% to 50% of patients with Graves’ disease. While endocrinologists primarily manage thyroid dysfunction, TED can severely impact a patient’s quality of life through vision loss, diplopia, and cosmetic concerns, necessitating active early intervention. Consequently, it is crucial for clinicians to be proficient in basic TED assessments for early diagnosis; however, many endocrinologists remain unfamiliar with these evaluations, which often leads to delayed treatment.
To usher in a new era of managing TED, a paradigm shift toward AI-based quantitative monitoring and precision care is explored in this session. Fundamental assessment methods, including the Clinical Activity Score (CAS), exophthalmos, and Margin-Reflex-Distance 1 (MRD1), will be introduced alongside clinical cases where AI-driven solutions provide objective and reproducible data. These cutting-edge tools go beyond simple diagnostic assistance by quantitatively tracking disease progression and treatment response, thereby facilitating highly personalized treatment plans. By integrating these innovative AI solutions, a comprehensive approach to TED management is presented, demonstrating how technology and innovation converge to solve long-standing clinical challenges and improve patient outcomes.
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Hendra ZufryIndonesia
Moderator
The Efficacy and Safety of Thyroid RFA: The Latest UpdatesRadiofrequency ablation (RFA) of the thyroid has emerged as a minimally invasive alternative to surgery for benign cystic and solid nodules, low risk papillary thyroid microcarcinoma (PTMC), and recurrent thyroid cancer. Standardized training and international guidelines have facilitated its global adoption. Long term efficacy and safety data position thyroid RFA as a primary treatment compared with other thermal techniques.
In recurrent thyroid cysts, RFA achieves a mean volume reduction ratio (VRR) of 87 ± 11.6 % after one session, outperforming ethanol ablation. For benign solid nodules, a single treatment yields 98.8 % VRR at ten year follow up. Larger nodules (> 20 mL) or multinodular goiters often require multiple sessions to optimize shrinkage, cosmesis, and symptom relief.
Autonomous thyroid nodules (ATNs) under 30 mL demonstrate rapid VRR and early TSH normalization, while larger ATNs reach approximately 70 % VRR by six months, correlating with euthyroidism. In indeterminate Bethesda III nodules with low suspicion ultrasound features, RFA delivers 87.4 % VRR at one year in surgery averse patients; Bethesda IV lesions achieve 94.9 ± 6.1 % VRR.
In low risk PTMC, RFA produces 100 % VRR without disrupting thyroid function over two years, offering an alternative to active surveillance. Early stage papillary thyroid cancers (T1a/T1b) show 99.31 % VRR at 48 months, with higher disappearance rates in T1a. In recurrent papillary carcinoma, RFA attains 100 % VRR and comparable disease free survival to reoperation, with fewer complications. A case of recurrent cervical medullary carcinoma reported 68.6 % VRR at six months.
Complication rates are low. Pre procedural risks include lidocaine toxicity; intra procedural events comprise pain, hematoma, burns, and transient voice changes; post procedural issues may involve mild thyroid dysfunction, discomfort, or rare nodule rupture. These events are generally mild and non–life threatening. Optimal outcomes depend on meticulous patient preparation, advanced electrode design, precise anatomic knowledge, judicious anesthesia, and high operator proficiency in basic and advanced RFA techniques. Patient satisfaction scores are consistently high, reflecting improved quality of life and favorable aesthetic outcomes.
Key Word : Thyroid RFA, Efficacy, Safety Profile, Long term Data.
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Jung Hwan BaekSouth Korea
Speaker
Standard and Advanced Techniques for Thyroid RFAThermal ablation, especially radiofrequency ablation (RFA), is promising technique not only for benign thyroid nodules but also for thyroid cancers. In various thyroid tumors, RFA effectively improves tumor-related symptoms and cosmetic problems by reducing tumor volume. RFA is recently adopted to recurrent and primary thyroid cancers. In terms of complication, major complication rate was reported as 1.4% - 8% according to the types, locations and size of the thyroid tumors.
Therefore, proper techniques and experience of operators are key factors to achieve effective and safe RFA. To maximize efficacy and to minimize complications, the Korean Society of Thyroid Radiology Guidelines (KSThR Guidelines 2012, 2017, and 2025) recommend the use of standard techniques; the perithyroidal lidocaine injection to control pain, trans-isthmic approach, moving-shot technique and hydrodissection (HD) technique. Furthermore, KSThR Guidelines recommend advanced techniques, such as vascular ablation, bolus injection of cold water (to manage nerve damage problems) or tracheal stent assisted RFA.
In this lecture, therefore I will introduce various standard and advanced techniques to maximize the ablation zone and to minimize injury of surrounding critical structures. Furthermore, I will briefly touch “how to combine proper device and techniques” for thyroid RFA.The Efficacy and Safety of RFA for PTMC in Long-Term Cohort Study: Do Above and BeyondThe incidence of thyroid cancer has increased not only in Korea, but in worldwide. This situation is mainly due to an increase in the over detection of small papillary thyroid carcinomas (PTCs) using high-resolution ultrasonography (US). Almost all newly detected thyroid cancers are small papillary thyroid cancers (PTCs), while the incidence of large PTCs and aggressive histological types has remained stable. In addition, mortality of thyroid cancer has remained stable in Korea. Therefore, several studies have suggested over-diagnosis of small thyroid cancers, especially papillary thyroid microcarcinomas (PTMC). Since the majority of PTMCs progress slowly and show excellent outcome and considering the drawbacks of surgery including voice change or hypoparathyroidism, it is time to re-evaluate the role of surgery (especially immediate surgery) for all biopsy proven PTMCs.
According to publications from South Korea and other countries, the incidence of thyroid carcinoma had increased 15-fold between 1993 and 2011; however, its mortality rate did not decrease. Moreover, the number of patients who suffered from surgical complications increased significantly. Considering the exceedingly low disease-specific mortality rate of PTMCs and the potential complications of thyroidectomy, it is imperative to consider alternative management strategies for PTMC management. Therefore, this lecture will review the current oncologic outcome (in both short and long-term follow-up studies) of thermal ablation in PTMC and compare it with the results of active surveillance and surgery.
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Vincent WuTaiwan
Moderator
From Taiwan to the World: The TAIPAI Journey Transforming Primary AldosteronismPrimary aldosteronism (PA) is an increasingly recognized cause of secondary hypertension, affecting an estimated 5%-15% of hypertensive patients. This condition, once thought to be rare, is now understood to be a relatively common contributor to high blood pressure, particularly in cases resistant to standard antihypertensive therapies. PA arises primarily from either bilateral adrenal hyperplasia or an aldosterone-producing adenoma. The pathophysiology of PA is characterized by excessive and autonomous secretion of aldosterone, an adrenal hormone that plays a critical role in regulating blood pressure and fluid balance.
Diagnosing PA involves a multi-step process, beginning with screening tests to identify at-risk individuals, followed by confirmatory tests, and finally, subtype differentiation to determine the specific cause of the condition. Screening is especially recommended for patients who present with certain risk factors, such as resistant hypertension, unexplained hypokalemia, or an onset of hypertension at a young age (under 40 years). Family history of PA, early signs of target organ damage, the presence of an adrenal incidentaloma, obstructive sleep apnea, unexplained atrial fibrillation, and psychosomatic symptoms are also significant indicators warranting screening. Additionally, patients with hypertension but no other comorbidities should be evaluated for PA, as it could be the underlying cause.
PA does not occur in isolation; it is often found to coexist with Mild Autonomous Cortisol Secretion (MACS). This co-occurrence presents a more complex clinical picture, as MACS can further aggravate the cardio-renal-vascular complications already associated with PA. Moreover, it can contribute to abnormalities in glucose metabolism, increasing the risk of diabetes and other metabolic disorders. One of the key challenges in the diagnosis and management of PA, particularly when MACS is present, lies in accurately interpreting the aldosterone-to-cortisol ratios during adrenal venous sampling, a critical step in subtype differentiation.
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Mitsuhide NaruseJapan
Speaker
Update in Primary AldosteronismPrimary aldosteronism (PA) is linked to significantly greater cardiovascular morbidity and mortality than essential hypertension, yet it offers a more favorable prognosis when appropriately treated. Early detection and targeted therapy are therefore essential for achieving optimal long-term outcomes and preserving quality of life.
Since the release of the Endocrine Society’s guidelines in 2010, several countries—including Japan—have developed national recommendations (e.g., Endocrine Journal, 2021). This reflects growing awareness and research momentum, with over 3,500 publications in the past decade. In Japan, we have established a national PA registry and conducted multicenter studies under the Japan Primary Aldosteronism Study (JPAS), supported by AMED, resulting in more than 40 publications as Japan-originated evidence.
Diagnostic protocols have become increasingly standardized, encompassing initial screening, confirmatory testing, subtype classification via adrenal venous sampling (AVS), and tailored treatment—mineralocorticoid receptor (MR) antagonists for bilateral PA and adrenalectomy for unilateral PA. The integration of PA screening into routine hypertension care, alongside the standardization of diagnostic methods, has led to substantial improvements in clinical practice.
However, key challenges remain. These include variability in assay methods (e.g., PRA vs. ARC for renin; CLEIA vs. RIA for aldosterone), which affects diagnostic thresholds; uncertainty regarding optimal cutoffs for
screening and confirmatory tests; lack of consensus on AVS protocols (with or without cosyntropin); and ongoing debates over the role of non-invasive imaging and advanced surgical approaches (laparoscopic vs. robot-assisted adrenalectomy).
These unresolved issues warrant evaluation through a cost-effectiveness lens. As PA diagnostics become increasingly integrated into hypertension management, a fundamental question emerges: How far should we go in diagnosing PA? This presentation will provide an updated overview of clinical practice and address these critical challenges in PA management.Do We Still Need Confirmatory Testing?
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Takashi AkamizuJapan
Speaker
History of AOCEThe 1st Asian-Oceanian Congress of Endocrinology (AOCE) was held in Kyoto in 1959, one year prior to the 1st International Congress of Endocrinology (ICE). Subsequently, the AOCE was held every four years until the 16th Congress in Yogyakarta, Indonesia, in 2018. Subsequently, AOCE shifted to a biennial schedule, with the 17th AOCE scheduled for Seoul, South Korea in 2020. However, the 18th AOCE was inevitably held online due to the COVID-19 pandemic. Now is an opportune moment to reflect on AOCE's history and move forward toward future development.
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Welcome Reception
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