Programme Day 2

• Lipoprotein(a): What Endocrinologists Need to Know
  Kathryn TanHong Kong, China Speaker Lipoprotein(a): What Endocrinologists Need to KnowLipoprotein(a) [Lp(a)] is a cholesterol-rich LDL-like particle with apolipoprotein(a) covalently linked to apolipoprotein B100 via a disulfide bond. Lp(a) is synthesized within the liver and there is a general inverse correlation between Lp(a) isoform size and plasma Lp(a) concentrations. About 90% of plasma Lp(a) concentration is genetically determined and plasma levels can modestly rise after menopause in women, and in conditions like hypothyroidism, nephrotic syndrome. It has been shown that elevated Lp(a) is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. Although Lp(a) concentration does vary with ethnicity, relationships between Lp(a) concentration and ASCVD risk remain similar across different ethnic groups. Elevated Lp(a) is considered a cardiovascular risk-enhancing or amplification factor, and recent guidelines and consensus have increasingly recommended universal screening for Lp(a). There are as yet, no approved therapies for elevated Lp(a). Current management focuses on intensifying control of concurrent risk factors, particularly LDL-C, to reduce ASCVD risk. Amongst existing lipid-lowering drugs, only proprotein convertase subtilisin/kexin type 9 inhibitors can lower Lp(a) levels modestly. Emerging RNA-based and small-molecule therapeutics are under development and are showing promising Lp(a)-lowering effects up to 80-90%. Ongoing phase 3 cardiovascular outcomes trials will determine whether effectively lowering Lp(a) can translate to cardiovascular benefit.
• Autologous Implantation of Genetically Modified Adipocytes Expressing LCAT for the Treatment of Familial LCAT Deficiency
  Masayuki KurodaJapan Speaker Autologous Implantation of Genetically Modified Adipocytes Expressing LCAT for the Treatment of Familial LCAT Deficiency
• Novel and Future Lipid-Lowering Therapy
  Sung Hee ChoiKorea Speaker Novel and Future Lipid-Lowering Therapy

• Clinical Pathways for Obesity Management
  I-Weng YenTaiwan Speaker Clinical Pathways for Obesity Management
• Anti-Obesity Medications: Clinical Use
  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.
• Obesity Care in Special Populations
  Chun Heng KuoTaiwan Speaker Obesity Care in Special Populations

• Psychological Burden in Diabetes: Understanding Distress and Its Clinical Impact
  Ye-Fong DuTaiwan Speaker Psychological Burden in Diabetes: Understanding Distress and Its Clinical Impact
• Enhancing Patient Experience in Diabetes Care: Communication and Empowerment Strategies
  Samuel ChenTaiwan Speaker Enhancing Patient Experience in Diabetes Care: Communication and Empowerment Strategies
• What Does Person-Centred Diabetes Care Really Mean in 2026?
  Amandeep SinghIndia Speaker
• Creating Happiness in the Diabetes Clinic: A Psychosocial Approach to Better Outcomes
  Sanjay KalraIndia Speaker Creating Happiness in the Diabetes Clinic: A Psychosocial Approach to Better Outcomes

• New Concept in Osteoporosis Management
  Daisuke InoueJapan Speaker New Concept in Osteoporosis Management- Japnaese Perspectives Operational definition of osteoporosis by WHO is currently "a BMD value -2.5SD or more below the young adult mean", which has been used worldwide for twenty years. WHO has recently initiated a process to revisit this definition as it is not sensitive enough to identify individuals at high risk of fracture, leading to unsatisfactory treatment of patients. Importantly, a history of fracture, particularly within the past two years (termed imminent fracture risk) has been shown to significantly contribute to the risk of subsequent fractures. Regarding a surrogate for evaluating the clinical efficacy of anti-osteoporotic drugs, a proposal from the FNIH-ASBMR-SABRE project has been submitted to the Food and Drug Administration (FDA). This proposal suggests that treatment-related increases in total hip BMD (TH-BMD) at two years could serve as a surrogate endpoint for fracture risk reduction in clinical trials. This is primarily based on the negative correlation observed between increases in total hip BMD and decreases in the incidence of hip fracture in various clinical trials of anti-osteoporotic drugs demonstrated by a meta-regression analysis. The significant role of BMD as a surrogate, along with availability of bone anabolic agents that can greatly increase BMD for a short period of time, has led to the concept of "Goal-directed treatment" of osteoporosis. Accordingly, "anabolic first" sequential therapy is recommended for individuals at high risk of fractures. In Japan, new Guidelines for Prevention and Treatment of Osteoporosis were issued on August 1, 2025. Recent trends in osteoporosis management, as described above, will be discussed in the context of these Japanese guidelines.
• Bone Fragility in Diabetes
  David LuiHong Kong, China Speaker Bone Fragility in Diabetes
• Metabolic Bone Disorder in Thalassemia
  Wen-Pin YangTaiwan Speaker Metabolic Bone Disorder in Thalassemia

• Long-Term Changes of Urinary Exosomal Peptide Levels after Thyroidectomy in Patients with Thyroid Cancer: A Prospective Observational Study
  Chih-Yuan WangTaiwan Speaker Obesity 2026 updateObesity remains one of the most critical and rapidly evolving global health challenges entering 2026, characterized by persistently rising prevalence, expanding clinical consequences, and profound societal and economic impacts. Over the past three decades, the prevalence of overweight and obesity has more than doubled among adults and increased nearly threefold among children and adolescents worldwide, driven by complex interactions between genetic susceptibility, obesogenic environments, sedentary lifestyles, dietary transitions toward energy-dense ultra-processed foods, and broader socio-economic determinants. Projections indicate that, if current trends continue, more than half of the global adult population and a substantial proportion of children will be living with obesity within the next two decades, with particularly rapid increases occurring in low- and middle-income countries undergoing nutritional and urban transitions. This epidemiologic shift has translated into a marked escalation in obesity-related non-communicable diseases, including type 2 diabetes, cardiovascular disease, chronic kidney disease, non-alcoholic fatty liver disease, osteoarthritis, and several obesity-associated malignancies, positioning excess adiposity as a leading contributor to global morbidity, mortality, and disability-adjusted life years. Alongside the growing disease burden, the conceptual framework of obesity has undergone important refinement. While body mass index remains a pragmatic population-level screening tool, its limitations in capturing adiposity distribution and metabolic risk have prompted international efforts to redefine obesity as a chronic, relapsing disease characterized by excess or dysfunctional adipose tissue with heterogeneous clinical expression. Emerging diagnostic paradigms increasingly emphasize waist-based measures, ectopic fat accumulation, and the presence of obesity-related complications, distinguishing pre-clinical obesity from clinically manifest disease and enabling more precise risk stratification and individualized management. Therapeutically, the obesity landscape has been transformed by advances in incretin-based pharmacotherapy, particularly glucagon-like peptide-1 receptor agonists and dual or multi-agonist agents, which have demonstrated unprecedented and sustained weight reduction alongside meaningful improvements in cardiometabolic outcomes. The recent development of effective oral formulations further expands treatment accessibility and has the potential to improve long-term adherence, although challenges related to cost, equity, and health-system implementation remain substantial. Importantly, pharmacotherapy alone is insufficient to address the obesity epidemic, and contemporary management strategies emphasize multimodal, life-course approaches integrating nutritional therapy, physical activity promotion, behavioral and psychological interventions, digital health technologies, and, when appropriate, metabolic and bariatric surgery, tailored to individual risk profiles and comorbidity burdens. At the population level, global policy initiatives increasingly recognize that obesity is not solely an individual responsibility but a systems-driven condition requiring coordinated action across healthcare, education, food systems, urban planning, and regulatory environments to create supportive contexts for healthy living. Concurrently, ongoing research continues to elucidate the complex pathophysiology of obesity, including the roles of genetics, epigenetics, gut microbiota, neuroendocrine regulation, and adipose tissue inflammation, while implementation science seeks to bridge gaps between evidence and real-world practice. Collectively, the 2026 obesity update portrays a paradoxical landscape of escalating global burden alongside unprecedented scientific and therapeutic progress, underscoring that meaningful and sustainable impact will depend on integrating biomedical innovation with structural policy reform, equitable access to care, and sustained public health commitment to reverse current trajectories and improve outcomes across the lifespan.Long-Term Changes of Urinary Exosomal Peptide Levels after Thyroidectomy in Patients with Thyroid Cancer: A Prospective Observational StudyIn this prospective observational study, we investigated whether longitudinal changes in urinary exosomal peptide profiles after thyroidectomy could predict recurrence risk in patients with papillary thyroid cancer, a disease with reported recurrence rates of up to 30%. Adults older than 20 years with newly diagnosed papillary thyroid cancer who had undergone thyroidectomy were enrolled, and urine samples were collected at 12 months after study entry and again one year later for exosomal peptide identification and comparison. Seventy patients were included and stratified according to the interval between surgery and enrollment (<5 years, 5–10 years, and >10 years). During the two-year follow-up after enrollment, no recurrences were observed. Across groups and time intervals, there were no significant differences in serum protein levels or urinary exosomal peptide concentrations, and established high-risk clinical factors showed only weak correlations with these biomarkers. Collectively, these findings delineate the long-term basal fluctuation ranges of serum proteins and urinary exosomal peptides in post-thyroidectomy thyroid cancer survivors, suggesting that biomarker levels remaining within these ranges may be indicative of a lower long-term risk of recurrence in high-risk patients following thyroidectomy.
• Salvage Radiofrequency Ablation Followed by External Beam Radiotherapy for Inoperable Recurrent Differentiated Thyroid Cancer
  Chen-Kai ChouTaiwan Speaker Salvage Radiofrequency Ablation Followed by External Beam Radiotherapy for Inoperable Recurrent Differentiated Thyroid Cancer
• Re-Differentiation Therapy in RAI-Refractory Thyroid Cancer
  Samantha Peiling YangSingapore Speaker Harnessing Molecular Diagnostics in Cytologically-Indeterminate Thyroid NodulesRe-Differentiation Therapy in RAI-Refractory Thyroid Cancer

• Sex-Specific Approaches in Precision Medicine: Advancing Endocrinology Care
  Shih-Li SuTaiwan Speaker Sex-Specific Approaches in Precision Medicine: Advancing Endocrinology CareSex differences are fundamental determinants of endocrine physiology and disease. Conventional approaches that treat men and women as biologically equivalent overlook variations in hormonal regulation, immune response, organ function, and pharmacologic metabolism. Precision medicine in endocrinology integrates these sex-specific biological and environmental factors to achieve individualized care. Emerging evidence shows that women are more prone to autoimmune thyroid disease, prolactinoma, and osteoporosis, largely due to estrogen-enhanced immune activity and X-chromosome dosage effects. Men, by contrast, experience higher rates of hypogonadism, visceral obesity, and aggressive endocrine tumors, reflecting androgen decline and single X-chromosome vulnerability. Hormonal effects, such as menopause-related bone loss, are often reversible, whereas chromosomal influences—such as those seen in Turner and Klinefelter syndromes—are irreversible and genetically determined. Pharmacokinetic and pharmacodynamic disparities further highlight the need for sex-informed dosing. Women generally have higher CYP3A4 activity and altered drug binding via increased sex hormone–binding globulin. In Asian populations, genetic polymorphisms, including the high prevalence of BRAF^V600E^ mutations in papillary thyroid cancer and variable androgen receptor CAG repeats, demand region-specific precision strategies. Sex-specific precision endocrinology moves beyond a uniform model of care by recognizing biological sex as a key variable in disease risk and treatment response. Incorporating sex-stratified analyses, adjusted diagnostic thresholds, and personalized pharmacotherapy can enhance diagnostic accuracy and therapeutic safety. For Asia, integrating genetic and environmental diversity is essential to advance equitable, individualized endocrine care.
• From the Bedside to the Digital World: Precision Medicine in Endocrinology with Al and ICT
  Miyuki KataiJapan Speaker From the Bedside to the Digital World: Precision Medicine in Endocrinology with Al and ICT
• Precision Medicine in Diabetes: Perspectives from Asia
  Ronald MaHong Kong, China Speaker Precision Medicine in Diabetes: Perspectives from AsiaChallenging Cases in Endocrinology

• (TBC)
  Tai Shuan LaiTaiwan Speaker

  Chun Liang LinTaiwan Moderator
• Investigating the Pathophysiological Role of Sweet Taste Receptor in the Development of Diabetes-
  Hung-Tsung WuTaiwan Speaker Investigating the Pathophysiological Role of Sweet Taste Receptor in the Development of Diabetes

  Horng-Yih Ou Moderator

• Understanding Biology of Type 2 Diabetes and Related Metabolic Disorders - In Memory of the Late Professor Tai Tong-Yuan
  Lee-Ming ChuangTaiwan Speaker Understanding Biology of Type 2 Diabetes and Related Metabolic Disorders - In Memory of the Late Professor Tai Tong-YuanType 2 diabetes mellitus is one of the major non-communicable diseases and has a huge medical and societal impact in recent years and the years to come. Earlier understanding of diabetes is mainly from descriptive observations and epidemiological studies, albeit that the criteria of dysglycemia was only finally revised in year 2010 (ADA) & 2011 (WHO). With advent of new technologies, research of diabetes has bloomed from molecular epidemiology to multi-omic studies. These advances have provided us an opportunity and challenge for better understanding and management of type 2 diabetes and related metabolic disorders. Based on several different unbiased approaches, such as family-based genome-wide linkage analyses, genome-wide association studies, and mRNA differential display, we had been able to tease out certain candidate genes which are responsible disease processes, including insulin resistance, adipogenesis, obesity, and type 2 diabetes. I will illustrate translational medical studies of the genes from each of those approaches, such as Ribosome Binding Protein 1 (RRBP1), adiponectin (ADIPOQ), Vascular Adhesion Protein (VAP1), nocturnin (NOCT), and Prostaglandin Reductase 2 (PTGR2), respectively. With the Stanford Asia–Pacific Program for Hypertension and Insulin Resistance (SAPPHIRe) cohort study, which was established in 1995, our ongoing studies not only provide us a better understanding of the genes/factors on metabolic disorders but also pave a path for developing potential treatment of insulin resistance and the related clinical disorders. References. 1. Diabetes (2005) 54: 1200–1206 2. Journal of Biomedical Science (2023) 30:13 3. J Clin Endocrinol Metab (2001) 86: 3815–3819 4. EMBO Molecular Medicine (2025) 17:938-966
• Research on Albuminuria in Taiwanese Patients with Type 2 Diabetes Mellitus
  Chin-Hsiao TsengTaiwan Speaker Research on Albuminuria in Taiwanese Patients with Type 2 Diabetes Mellitus
• (TBC)
  Wei-Shiung Yang Speaker

• SGLT2 Inhibitors as a Novel Approach in Nephrolithiasis: Modulating Autophagy and Lysosomal Function
  Chan-Jung LiuTaiwan Speaker SGLT2 Inhibitors as a Novel Approach in Nephrolithiasis: Modulating Autophagy and Lysosomal Function

  Chieh-Hsiang LuTaiwan Moderator
• Panel Discussion
  Chih-Yuan WangTaiwan Moderator Obesity 2026 updateObesity remains one of the most critical and rapidly evolving global health challenges entering 2026, characterized by persistently rising prevalence, expanding clinical consequences, and profound societal and economic impacts. Over the past three decades, the prevalence of overweight and obesity has more than doubled among adults and increased nearly threefold among children and adolescents worldwide, driven by complex interactions between genetic susceptibility, obesogenic environments, sedentary lifestyles, dietary transitions toward energy-dense ultra-processed foods, and broader socio-economic determinants. Projections indicate that, if current trends continue, more than half of the global adult population and a substantial proportion of children will be living with obesity within the next two decades, with particularly rapid increases occurring in low- and middle-income countries undergoing nutritional and urban transitions. This epidemiologic shift has translated into a marked escalation in obesity-related non-communicable diseases, including type 2 diabetes, cardiovascular disease, chronic kidney disease, non-alcoholic fatty liver disease, osteoarthritis, and several obesity-associated malignancies, positioning excess adiposity as a leading contributor to global morbidity, mortality, and disability-adjusted life years. Alongside the growing disease burden, the conceptual framework of obesity has undergone important refinement. While body mass index remains a pragmatic population-level screening tool, its limitations in capturing adiposity distribution and metabolic risk have prompted international efforts to redefine obesity as a chronic, relapsing disease characterized by excess or dysfunctional adipose tissue with heterogeneous clinical expression. Emerging diagnostic paradigms increasingly emphasize waist-based measures, ectopic fat accumulation, and the presence of obesity-related complications, distinguishing pre-clinical obesity from clinically manifest disease and enabling more precise risk stratification and individualized management. Therapeutically, the obesity landscape has been transformed by advances in incretin-based pharmacotherapy, particularly glucagon-like peptide-1 receptor agonists and dual or multi-agonist agents, which have demonstrated unprecedented and sustained weight reduction alongside meaningful improvements in cardiometabolic outcomes. The recent development of effective oral formulations further expands treatment accessibility and has the potential to improve long-term adherence, although challenges related to cost, equity, and health-system implementation remain substantial. Importantly, pharmacotherapy alone is insufficient to address the obesity epidemic, and contemporary management strategies emphasize multimodal, life-course approaches integrating nutritional therapy, physical activity promotion, behavioral and psychological interventions, digital health technologies, and, when appropriate, metabolic and bariatric surgery, tailored to individual risk profiles and comorbidity burdens. At the population level, global policy initiatives increasingly recognize that obesity is not solely an individual responsibility but a systems-driven condition requiring coordinated action across healthcare, education, food systems, urban planning, and regulatory environments to create supportive contexts for healthy living. Concurrently, ongoing research continues to elucidate the complex pathophysiology of obesity, including the roles of genetics, epigenetics, gut microbiota, neuroendocrine regulation, and adipose tissue inflammation, while implementation science seeks to bridge gaps between evidence and real-world practice. Collectively, the 2026 obesity update portrays a paradoxical landscape of escalating global burden alongside unprecedented scientific and therapeutic progress, underscoring that meaningful and sustainable impact will depend on integrating biomedical innovation with structural policy reform, equitable access to care, and sustained public health commitment to reverse current trajectories and improve outcomes across the lifespan.Long-Term Changes of Urinary Exosomal Peptide Levels after Thyroidectomy in Patients with Thyroid Cancer: A Prospective Observational StudyIn this prospective observational study, we investigated whether longitudinal changes in urinary exosomal peptide profiles after thyroidectomy could predict recurrence risk in patients with papillary thyroid cancer, a disease with reported recurrence rates of up to 30%. Adults older than 20 years with newly diagnosed papillary thyroid cancer who had undergone thyroidectomy were enrolled, and urine samples were collected at 12 months after study entry and again one year later for exosomal peptide identification and comparison. Seventy patients were included and stratified according to the interval between surgery and enrollment (<5 years, 5–10 years, and >10 years). During the two-year follow-up after enrollment, no recurrences were observed. Across groups and time intervals, there were no significant differences in serum protein levels or urinary exosomal peptide concentrations, and established high-risk clinical factors showed only weak correlations with these biomarkers. Collectively, these findings delineate the long-term basal fluctuation ranges of serum proteins and urinary exosomal peptides in post-thyroidectomy thyroid cancer survivors, suggesting that biomarker levels remaining within these ranges may be indicative of a lower long-term risk of recurrence in high-risk patients following thyroidectomy.

• Update in Osteoporosis
  Dolores ShobackUnited States Speaker Update in OsteoporosisMany issues in osteoporosis management are challenging in clinical practice. Factors in fracture risk assessment include those in the FRAX algorithm as well as imminent fracture risk in the next 1-5 years. Highest risk individuals benefit most from aggressive therapies targeted to increase bone mineral density (BMD) and reduce fracture rates as rapidly as possible to enhance bone strength. Sequential therapeutic strategies with repeated courses of both anabolic and antiresorptive treatments are becoming the norm for highest risk patients. Yet clinicians are often without trial data to predict clinical outcomes. Bisphosphonate treatment holidays are often employed to allow for a return of bone remodeling with the goal of microdamage repair and avoiding oversuppression of turnover. Yet the duration and monitoring of such treatment interruptions have not been rigorously established. The safety and efficacy of repeated courses of anabolic agents in the lifespan of a patient have not been well studied. The biologic basis for achieving effective BMD responses in sequential therapy is not known. Despite the long use of denosumab and bisphosphonates in clinical care, how to interrupt safely, and how to sequence these therapies most effectively are not known. Rebound increases in bone remodeling after stopping treatment with the RANK-ligand inhibitor denosumab and the challenges of treating patients with advanced chronic kidney disease with denosumab remain unsolved. The bifunctional monoclonal antibody to sclerostin romosozumab, while potent at increasing BMD due to its anabolic and antiresorptive actions, may have off-target cardiovascular adverse effects. Patients who are obese or with diabetes using GLP1 receptor agonists and SGLT2 inhibitors have risks to bone health with rapid weight loss and or direct effects on bone. Ultimately, clinicians must make decisions on patient management based on individual risk assessment and anticipated pathophysiology of the low BMD and risk in that patient.Challenging Parathyroid Cases

• Exploring the World of Autoimmune Disease: from Genetic Manipulation to Disease Reversal
  Huey-Kang SytwuTaiwan Speaker Exploring the World of Autoimmune Disease: from Genetic Manipulation to Disease Reversal

• Do We Still Need Confirmatory Testing?
  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?
• Skipping Confirmatory Tests: Modern Simplified Pathways
  Ada E. D. TeoSingapore Speaker Skipping Confirmatory Tests: Modern Simplified Pathways
• From ARR to Subtyping: Practical Strategies for Streamlining Testing, Imaging, and AVS in Daily Practice
  Wasita Warachit ParksookThailand Speaker From ARR to Subtyping: Practical Strategies for Streamlining Testing, Imaging, and AVS in Daily Practice
• Medical vs Surgical Treatment in 2026: Optimizing MRA Therapy, ENaC Strategies, and Surgical Decision-Making
  Cheng Hsuan TsaiTaiwan Speaker Medical vs Surgical Treatment in 2026: Optimizing MRA Therapy, ENaC Strategies, and Surgical Decision-Making
• Discussion

• Key Highlights of the American Thyroid Association Thyroid and Pregnancy Guidelines
  Angela M. LeungUnited States Speaker Key Highlights of the American Thyroid Association Thyroid and Pregnancy GuidelinesThis session will present the key highlights of the American Thyroid Association 2026 guidelines for thyroid disease in preconception, pregnancy, and postpartum that have been published by a multidisciplinary group of experts with global perspective. The discussion will provide an overview of the methodology used to prepare these updated guidelines in partnership with and endorsed by several other collaborating societies. The presentation will cover the most notable changes and new recommendations surrounding thyroid function testing, iodine nutrition, infertility and assisted reproductive techniques, hypothyroidism, hyperthyroidism (including Graves’ disease), thyroid nodules, and thyroid cancers for women planning pregnancy, are pregnant, or seen for postpartum care.Thyroid Risks of Iodine ExcessIodine is a micronutrient that is required for the production of thyroid hormone. Iodine is commonly obtained from consuming an iodine-rich diet or iodine-fortified foods, amiodarone use, iodine-containing supplements, and iodinated contrast media. This session will review the potential forms of thyroid dysfunction arising from an acute iodine load, due to the failure to escape from the Wolff-Chaikoff effect and to the Jod-Basedow phenomenon. The risks of iodine excess in vulnerable populations, and current guidelines regarding the screening and monitoring of iodinated contrast-induced thyroid dysfunction, will be summarized.
• Precision Medicine in Gestational Thyroid Disease: Taking Care of Mother and Baby
  Marjorie A. RamosPhilippines Speaker Precision Medicine in Gestational Thyroid Disease: Taking Care of Mother and BabyPrecision medicine is revolutionizing the management of thyroid disorders in pregnancy by emphasizing individualized diagnosis, trimester-specific reference ranges, and tailored treatment strategies. Thyroid dysfunction is the second most common endocrine abnormality during gestation which poses significant risks to both maternal and fetal health, including miscarriage, preterm delivery, and impaired neurodevelopment. Guidelines now emphasize routine screening in high-risk populations, with tailored management protocols based on trimester-specific TSH and free T4 targets. For hypothyroidism, levothyroxine therapy is initiated early and titrated to maintain TSH in the lower half of the trimester-specific reference range, while hyperthyroidism is managed with antithyroid drugs at the lowest effective dose to minimize fetal risks. Recent updates to clinical guidelines highlight recommendations, including the importance of shared decision-making for women with Graves’ disease, and a shift from antibody-based to timing-based criteria for the treatment of subclinical hypothyroidism. These updates reflect evolving evidence from large randomized trials and systematic reviews, underscoring the need for flexibility and individualization in clinical practice. Future directions in precision medicine include the integration of genetic and molecular profiling to predict disease risk, response to therapy, and long-term outcomes. Machine learning and artificial intelligence are also being explored to enhance diagnostic accuracy and personalize prevention strategies for high-risk subgroups. By combining cutting-edge diagnostics with tailored therapeutic interventions, precision medicine aims to maximize maternal and fetal well-being, reduce adverse outcomes, and improve the overall quality of care for pregnant women with thyroid disorders. This presentation will review the latest evidence, guideline updates, and future innovations in precision medicine for gestational thyroid disease, providing clinicians with practical tools and insights for optimizing patient management in clinical practice and research settings
• Iodine Status in Pregnant Women in Taiwan
  Fan-Fen WangTaiwan Speaker Iodine Status in Pregnant Women in TaiwanIn the 1940’s, endemic goiter was the fifth most common disease in Taiwan. Then, in 1967, an island-wide salt-iodization campaign using 33 ppm potassium iodate was started. Four years after implementation of the campaign, goiter rates among schoolchildren had decreased from 21.6% to 4.3%, suggesting successful elimination of iodine deficiency. However, the mandatory salt iodization policy was discontinued in 2002. In recent surveys, the iodine nutrition status of the overall Taiwanese population has been found to be sufficient, but is at borderline level in pregnant women. Socioeconomic, environmental factors contribute to the incident iodine deficiency in subgroups. While about 92% of pregnant women in Taiwan take nutritional supplements, only about 49% take iodine-containing multi-vitamins. The iodine content of daily meals in Taiwan is currently under investigation, to support targeted dietary education and food fortification programs, which are indicated to improve the iodine status of pregnant women in Taiwan.

• Assessing and Managing Osteoporosis in Patients with Diabetes
  Jawl-Shan HwangTaiwan Speaker Assessing and Managing Osteoporosis in Patients with Diabetes
• Diabetes and Osteoarthritis: Metabolic Links and Clinical Implications
  Jia-Feng Chen Speaker Diabetes and Osteoarthritis: Metabolic Links and Clinical Implications
• Sarcopenia in Diabetes: Pathophysiology, Diagnosis, and Management
  Tung-Wei KaoTaiwan Speaker Sarcopenia in Diabetes: Pathophysiology, Diagnosis, and Management

• PitNET (aka Pituitary Adenomas) in Multiple Endocrine Neoplasm
  Sang Ouk ChinCanada Speaker PitNET (aka Pituitary Adenomas) in Multiple Endocrine Neoplasm
• Oncologist Perspective of NET Management
  Stephen ChanHong Kong, China Speaker Oncologist Perspective of NET Management
• Functional NET
  Shyang-Rong ShihTaiwan Speaker Functional NET

• Mechanistic Insights into the Gut–Liver–Brain Axis in MASLD: Metabolic Crosstalk and Neuroinflammation
  Lee-Ling LimMalaysia Speaker Mechanistic Insights into the Gut–Liver–Brain Axis in MASLD: Metabolic Crosstalk and NeuroinflammationThe gut–liver–brain axis plays an important role in the pathogenesis and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Disruptions in gut microbiota, increased intestinal permeability, and microbial metabolites drive hepatic lipotoxicity and systemic inflammation. These hepatic signals, together with other metabolic dysfunctions, worsen neuroinflammatory responses and metabolic dysregulation. This lecture will discuss mechanistic links across the axis, and understanding these interconnected mechanisms offers opportunities to refine risk stratification and develop targeted interventions that address MASLD as a multisystem disease.Early-Onset Diabetes: Expanding the Spectrum of ComplicationsEarly-onset diabetes is increasing globally and is characterized by an accelerated trajectory of metabolic dysfunction. People diagnosed at a younger age experience a longer lifetime exposure to hyperglycaemia, adiposopathy, and inflammation, leading to an expanded spectrum of complications. Emerging evidence highlights earlier onset of kidney disease, heart failure, fatty liver disease, cognitive decline, and mental health disorders in this high-risk population. This lecture will synthesize current epidemiology, mechanistic insights, and evolving phenotypes, underscoring the urgent need for precision prevention, aggressive risk-factor modification, and integrated care models to reduce premature morbidity and mortality.
• MASLD and Cognitive Impairment Correlate with Diabetic Management
  Noriko Satoh-AsaharaJapan Speaker 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.
• Diabetes Mellitus-Dementia Correlate with Diabetic Management
  Chaur-Jong HuTaiwan Speaker Diabetes Mellitus-Dementia Correlate with Diabetic ManagementDiabetes mellitus (DM) is a major metabolic disorder that substantially increases the risk of cognitive decline and dementia, including Alzheimer’s disease (AD) and vascular dementia. Growing evidence indicates that chronic hyperglycemia, insulin resistance, vascular injury, oxidative stress, and neuroinflammation are key mechanisms linking DM to neurodegeneration. Insulin resistance in the brain disrupts neuronal glucose utilization, enhances tau phosphorylation, and accelerates amyloid-β accumulation, while advanced glycation end-products (AGEs) and diabetes-related microvascular dysfunction further exacerbate neuronal injury. Effective diabetic management plays a critical role in mitigating dementia risk. Antidiabetic agents such as metformin, thiazolidinediones, and particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated neuroprotective effects beyond glycemic control. GLP-1RAs improve insulin signaling, reduce neuroinflammation, enhance mitochondrial function, promote autophagy, and inhibit apoptosis, leading to preserved cognitive functions in preclinical models. Clinical studies show that GLP-1RAs may improve specific cognitive domains in patients with type 2 DM and reduce the incidence of cognitive impairment. However, the recent phase 3 trials, Eoke and Evoke+ failed to show the beneficial effects on AD. Overall, the strong interplay between DM and dementia highlights the necessity of optimal glycemic control and strategic use of antidiabetic therapies with neuroprotective potential. Integrating metabolic management into dementia prevention frameworks may offer an effective approach to reducing the global burden of cognitive disorders.

• Consensus in Pituitary Pathology: Impact after New Classification for Japan
  Naoko InoshitaJapan Speaker Consensus in Pituitary Pathology: Impact after New Classification for Japan
• The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?
  Szu-Tah ChenTaiwan Speaker The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?The 2022 World Health Organization (WHO) Classification of Endocrine and Neuroendocrine Tumors redefined pituitary adenomas as pituitary neuroendocrine tumors (PitNETs) within the International Classification of Diseases for Oncology, 3rd Edition (ICD-O/3). This change reflects updated insights into tumor biology, recognizing a spectrum of clinical behaviors beyond the traditionally benign designation. A narrative review of the WHO 2022 classification updates was conducted, focusing on their clinical, diagnostic, and epidemiologic implications for practitioners in endocrinology, neurosurgery, and oncology. The reclassification emphasizes the potential for variability in tumor aggressiveness, recurrence, and invasiveness. Clinically, this shift necessitates more careful risk stratification, closer follow-up in selected cases, and a reassessment of treatment algorithms. From a reporting perspective, ICD-O/3 alignment may affect cancer registry data and epidemiologic tracking, altering disease burden estimates. Importantly, the new terminology presents challenges in patient communication, as the label “neuroendocrine tumor” may cause undue anxiety despite the indolent nature of most PitNETs. The WHO 2022 reclassification of pituitary adenomas as PitNETs represents a significant change for clinical practice. While it enhances awareness of potential aggressive behavior, it also requires balanced application in patient care to avoid overtreatment and misperceptions. Practitioners must adapt by refining diagnostic vigilance, tailoring follow-up strategies, and delivering clear patient-centered communication.
• Consensus in Pituitary Pathology: Impact after New Classification for Korea
  Jae Sung ParkSouth Korea Speaker Consensus in Pituitary Pathology: Impact after New Classification for Korea

• Brain Remodeling of Appetite Centers in Obesity - Results from Murine Omics Studies and Human Brain Imaging
  Tomohiro TanakaJapan Speaker Brain Remodeling of Appetite Centers in Obesity - Results from Murine Omics Studies and Human Brain Imaging
• Obesity Management: What's New?
  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).
• The Hidden Barrier: Understanding and Overcoming Weight Bias
  Hai-Hua ChuangTaiwan Speaker The Hidden Barrier: Understanding and Overcoming Weight Bias

• Obesity 2026 Update
  Chih-Yuan WangTaiwan Speaker Obesity 2026 updateObesity remains one of the most critical and rapidly evolving global health challenges entering 2026, characterized by persistently rising prevalence, expanding clinical consequences, and profound societal and economic impacts. Over the past three decades, the prevalence of overweight and obesity has more than doubled among adults and increased nearly threefold among children and adolescents worldwide, driven by complex interactions between genetic susceptibility, obesogenic environments, sedentary lifestyles, dietary transitions toward energy-dense ultra-processed foods, and broader socio-economic determinants. Projections indicate that, if current trends continue, more than half of the global adult population and a substantial proportion of children will be living with obesity within the next two decades, with particularly rapid increases occurring in low- and middle-income countries undergoing nutritional and urban transitions. This epidemiologic shift has translated into a marked escalation in obesity-related non-communicable diseases, including type 2 diabetes, cardiovascular disease, chronic kidney disease, non-alcoholic fatty liver disease, osteoarthritis, and several obesity-associated malignancies, positioning excess adiposity as a leading contributor to global morbidity, mortality, and disability-adjusted life years. Alongside the growing disease burden, the conceptual framework of obesity has undergone important refinement. While body mass index remains a pragmatic population-level screening tool, its limitations in capturing adiposity distribution and metabolic risk have prompted international efforts to redefine obesity as a chronic, relapsing disease characterized by excess or dysfunctional adipose tissue with heterogeneous clinical expression. Emerging diagnostic paradigms increasingly emphasize waist-based measures, ectopic fat accumulation, and the presence of obesity-related complications, distinguishing pre-clinical obesity from clinically manifest disease and enabling more precise risk stratification and individualized management. Therapeutically, the obesity landscape has been transformed by advances in incretin-based pharmacotherapy, particularly glucagon-like peptide-1 receptor agonists and dual or multi-agonist agents, which have demonstrated unprecedented and sustained weight reduction alongside meaningful improvements in cardiometabolic outcomes. The recent development of effective oral formulations further expands treatment accessibility and has the potential to improve long-term adherence, although challenges related to cost, equity, and health-system implementation remain substantial. Importantly, pharmacotherapy alone is insufficient to address the obesity epidemic, and contemporary management strategies emphasize multimodal, life-course approaches integrating nutritional therapy, physical activity promotion, behavioral and psychological interventions, digital health technologies, and, when appropriate, metabolic and bariatric surgery, tailored to individual risk profiles and comorbidity burdens. At the population level, global policy initiatives increasingly recognize that obesity is not solely an individual responsibility but a systems-driven condition requiring coordinated action across healthcare, education, food systems, urban planning, and regulatory environments to create supportive contexts for healthy living. Concurrently, ongoing research continues to elucidate the complex pathophysiology of obesity, including the roles of genetics, epigenetics, gut microbiota, neuroendocrine regulation, and adipose tissue inflammation, while implementation science seeks to bridge gaps between evidence and real-world practice. Collectively, the 2026 obesity update portrays a paradoxical landscape of escalating global burden alongside unprecedented scientific and therapeutic progress, underscoring that meaningful and sustainable impact will depend on integrating biomedical innovation with structural policy reform, equitable access to care, and sustained public health commitment to reverse current trajectories and improve outcomes across the lifespan.Long-Term Changes of Urinary Exosomal Peptide Levels after Thyroidectomy in Patients with Thyroid Cancer: A Prospective Observational StudyIn this prospective observational study, we investigated whether longitudinal changes in urinary exosomal peptide profiles after thyroidectomy could predict recurrence risk in patients with papillary thyroid cancer, a disease with reported recurrence rates of up to 30%. Adults older than 20 years with newly diagnosed papillary thyroid cancer who had undergone thyroidectomy were enrolled, and urine samples were collected at 12 months after study entry and again one year later for exosomal peptide identification and comparison. Seventy patients were included and stratified according to the interval between surgery and enrollment (<5 years, 5–10 years, and >10 years). During the two-year follow-up after enrollment, no recurrences were observed. Across groups and time intervals, there were no significant differences in serum protein levels or urinary exosomal peptide concentrations, and established high-risk clinical factors showed only weak correlations with these biomarkers. Collectively, these findings delineate the long-term basal fluctuation ranges of serum proteins and urinary exosomal peptides in post-thyroidectomy thyroid cancer survivors, suggesting that biomarker levels remaining within these ranges may be indicative of a lower long-term risk of recurrence in high-risk patients following thyroidectomy.

• Incretin-Based Therapeutics: Bridging Theory and Practice, and Exploring New Horizons
  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.

• Genomic Alterations in Thyroid Cancer: Biological and Clinical Insights
  Maria E. CabanillasUnited States Speaker Genomic Alterations in Thyroid Cancer: Biological and Clinical InsightsAnaplastic Thyroid Cancer

• Early-Onset Diabetes: Expanding the Spectrum of Complications
  Lee-Ling LimMalaysia Speaker Mechanistic Insights into the Gut–Liver–Brain Axis in MASLD: Metabolic Crosstalk and NeuroinflammationThe gut–liver–brain axis plays an important role in the pathogenesis and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Disruptions in gut microbiota, increased intestinal permeability, and microbial metabolites drive hepatic lipotoxicity and systemic inflammation. These hepatic signals, together with other metabolic dysfunctions, worsen neuroinflammatory responses and metabolic dysregulation. This lecture will discuss mechanistic links across the axis, and understanding these interconnected mechanisms offers opportunities to refine risk stratification and develop targeted interventions that address MASLD as a multisystem disease.Early-Onset Diabetes: Expanding the Spectrum of ComplicationsEarly-onset diabetes is increasing globally and is characterized by an accelerated trajectory of metabolic dysfunction. People diagnosed at a younger age experience a longer lifetime exposure to hyperglycaemia, adiposopathy, and inflammation, leading to an expanded spectrum of complications. Emerging evidence highlights earlier onset of kidney disease, heart failure, fatty liver disease, cognitive decline, and mental health disorders in this high-risk population. This lecture will synthesize current epidemiology, mechanistic insights, and evolving phenotypes, underscoring the urgent need for precision prevention, aggressive risk-factor modification, and integrated care models to reduce premature morbidity and mortality.

• Thyroid Risks of Iodine Excess
  Angela M. LeungUnited States Speaker Key Highlights of the American Thyroid Association Thyroid and Pregnancy GuidelinesThis session will present the key highlights of the American Thyroid Association 2026 guidelines for thyroid disease in preconception, pregnancy, and postpartum that have been published by a multidisciplinary group of experts with global perspective. The discussion will provide an overview of the methodology used to prepare these updated guidelines in partnership with and endorsed by several other collaborating societies. The presentation will cover the most notable changes and new recommendations surrounding thyroid function testing, iodine nutrition, infertility and assisted reproductive techniques, hypothyroidism, hyperthyroidism (including Graves’ disease), thyroid nodules, and thyroid cancers for women planning pregnancy, are pregnant, or seen for postpartum care.Thyroid Risks of Iodine ExcessIodine is a micronutrient that is required for the production of thyroid hormone. Iodine is commonly obtained from consuming an iodine-rich diet or iodine-fortified foods, amiodarone use, iodine-containing supplements, and iodinated contrast media. This session will review the potential forms of thyroid dysfunction arising from an acute iodine load, due to the failure to escape from the Wolff-Chaikoff effect and to the Jod-Basedow phenomenon. The risks of iodine excess in vulnerable populations, and current guidelines regarding the screening and monitoring of iodinated contrast-induced thyroid dysfunction, will be summarized.

• Challenging Parathyroid Cases
  Dolores ShobackUnited States Speaker Update in OsteoporosisMany issues in osteoporosis management are challenging in clinical practice. Factors in fracture risk assessment include those in the FRAX algorithm as well as imminent fracture risk in the next 1-5 years. Highest risk individuals benefit most from aggressive therapies targeted to increase bone mineral density (BMD) and reduce fracture rates as rapidly as possible to enhance bone strength. Sequential therapeutic strategies with repeated courses of both anabolic and antiresorptive treatments are becoming the norm for highest risk patients. Yet clinicians are often without trial data to predict clinical outcomes. Bisphosphonate treatment holidays are often employed to allow for a return of bone remodeling with the goal of microdamage repair and avoiding oversuppression of turnover. Yet the duration and monitoring of such treatment interruptions have not been rigorously established. The safety and efficacy of repeated courses of anabolic agents in the lifespan of a patient have not been well studied. The biologic basis for achieving effective BMD responses in sequential therapy is not known. Despite the long use of denosumab and bisphosphonates in clinical care, how to interrupt safely, and how to sequence these therapies most effectively are not known. Rebound increases in bone remodeling after stopping treatment with the RANK-ligand inhibitor denosumab and the challenges of treating patients with advanced chronic kidney disease with denosumab remain unsolved. The bifunctional monoclonal antibody to sclerostin romosozumab, while potent at increasing BMD due to its anabolic and antiresorptive actions, may have off-target cardiovascular adverse effects. Patients who are obese or with diabetes using GLP1 receptor agonists and SGLT2 inhibitors have risks to bone health with rapid weight loss and or direct effects on bone. Ultimately, clinicians must make decisions on patient management based on individual risk assessment and anticipated pathophysiology of the low BMD and risk in that patient.Challenging Parathyroid Cases

• Anaplastic Thyroid Cancer
  Maria E. CabanillasUnited States Speaker Genomic Alterations in Thyroid Cancer: Biological and Clinical InsightsAnaplastic Thyroid Cancer